PhD Swim School Online Registration

Registration

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Thank you so much for choosing PhD Swim School! We look forward to swimming with you! Please use the following form to register if you are a new family. All non-swimmers need to register for Survival. You do NOT need to select a class if you are signing up to be notified about the Sept/Oct session. Your credit card will NOT be charged until you actually select a class when registration begins.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Click to Enter an International Number

Additional Info

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Click to Enter an International Number

Cell # *

Click to Enter an International Number

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Medications

Swim level*

New Students: Register for Survival unless they can already swim in deep water. This class is taught three days per week, one on one. Upon completion of the survival course, students may move on to weekly semi-private classes.

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Medications

Swim level*

New Students: Register for Survival unless they can already swim in deep water. This class is taught three days per week, one on one. Upon completion of the survival course, students may move on to weekly semi-private classes.

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Medications

Swim level*

New Students: Register for Survival unless they can already swim in deep water. This class is taught three days per week, one on one. Upon completion of the survival course, students may move on to weekly semi-private classes.

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Medications

Swim level*

New Students: Register for Survival unless they can already swim in deep water. This class is taught three days per week, one on one. Upon completion of the survival course, students may move on to weekly semi-private classes.

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Medications

Swim level*

New Students: Register for Survival unless they can already swim in deep water. This class is taught three days per week, one on one. Upon completion of the survival course, students may move on to weekly semi-private classes.

Enroll in Classes

Add Another Student

Required Policies and Agreements

Payment Terms

Tuition is due in full at time of enrollment. NOT REGISTRATION
Weekly classes (i.e. not survival) auto enroll each session. Students may cancel the entire swim session up to the 15th of the upcoming month by signing up for "Drop Class," which is located in the 'enroll' tab of your Family Portal. If you do not withdraw by the 15th of the upcoming month, you will be responsible for full monthly payment. Verbal notice, text messages, emails, portal messages, phone calls, etc are not considered a withdrawal.
Notifying after the 15th of the upcoming month is not considered a withdrawal.
Payment for lessons is non-refundable.
PhD Swim School reserves the right to refuse services and/or deactivate your Family Portal account if payment is not received at time of class enrollment.

I've read the above and agree.

Why no refunds

Please do not begin our program unless you understand that there may be resistant/"fussy" behavior from your child and fully intend to complete the course.
Many children are resistant in the first few weeks of lessons. This comes from a lack of confidence due to being unskilled in the water.
We place a firm financial responsibility on you in order to ensure that your child will not be subjected to these fears. Therefore, please make sure our program is for you (we know it's for your child) before registering.

I've read the above and agree.

Registration Fee

PhD Swim School requires a one time Family Registration Fee of $50 at time of class enrollment, NOT REGISTRATION.

I've read the above and agree.

Missed Classes

Students are not entitled to make-up classes due to student absence or tuition deductions for any absences.
Students who are late will receive an abbreviated lesson.

I've read the above and agree.

Diet Requirements

Students in the I Can Swim! Survival Program under age 3 must NOT eat 2 hours before their lesson.
4 hours before their lesson, avoid whole fruits (especially with skin), meats, dairy products, and anything difficult to digest. Students may have rice cereal, applesauce, bananas, toast, breast milk, and nut protein 4 hours before their lesson.
Students swallow air during the lesson process and we must avoid spitting up in the pool. It does not harm the student, but the pool must be closed if such an incident occurs.

I've read the above and agree.

Diaper Requirements

Students under age 3 OR not fully potty trained must wear two swim diapers at every lesson. At least one of these diapers must be NON-DISPOSABLE (plastic, not paper). Disposable diapers alone do not prevent contamination.
If a fecal incident occurs in the pool, the entire pool must be closed and all lessons canceled.
A fee of $500 will apply if a fecal contamination incident is caused by your child and you were not following this policy.
Please do not leave messy or wet diapers on the pool deck.

I've read the above and agree.

Pool Rules

MAIN LOCATION (2105 NC Hwy 54):
No open swim is allowed.
Children should enter the water only when their lesson begins and exit the water after their lesson.
Parents and other children must remain in the designated play/waiting area and are not allowed to stand or sit beside the pool. No food or drink is allowed.

ORANGE COUNTY SPORTSPLEX (101 Meadowlands Drive):
There is no facility fee for your child during his or her lesson time. If other family members wish to swim, or you wish to play in the pool before or after your lesson, you must pay a guest fee to the front desk.
We ask that you sit in the chairs provided and do not sit or stand right beside the pool.
Other children must be kept beside you or on your lap and are not allowed to roam around the pool.

I've read the above and agree.

Image Release

In consideration of participation in PhD Swim School, the undersigned agrees that their likeness,
or the likeness of their child/ward may be photographed or videotaped and that such image may
be published in an outlet used to promote or publicize the sports program.

I've read the above and agree.

Waiver/Relase of Liability

In consideration of being allowed to participate in any way in PhD Swim School's athletic sports
program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1) The risk of injury from the activities involved in this program is significant, including the potential forpermanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility
for my participation; and,
3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND HOLD HARMLESS Katherine Cleary/PhD Swim School, their officers, officials,
agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*