Atlanta Swim School Online Registration

Registration

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Welcome to Atlanta Swim School! Please complete the following registration form to get started.

* 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*

Additional Info

Emergency Contact*

Contact #1

Contact #1 First Name*

Last Name *

Relationship to Student*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Relationship to Student

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Skill Notes

Swimming lessons before? *

Any fear of the water?*

List swimming goals.*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Skill Notes

Swimming lessons before? *

Any fear of the water?*

List swimming goals.*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Skill Notes

Swimming lessons before? *

Any fear of the water?*

List swimming goals.*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Skill Notes

Swimming lessons before? *

Any fear of the water?*

List swimming goals.*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Skill Notes

Swimming lessons before? *

Any fear of the water?*

List swimming goals.*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk/Release of Liability

As the parent or legal guardian of the child(ren) listed with this booking and/or as the adult listed with this booking, I agree and understand that swimming is a hazardous activity. I recognize that there are risks inherent in the sport of swimming, including, but not limited to paralyzing injuries and death.

The participant hereby agrees to participate in the Atlanta Swim School swim lessons and programs and hereby agrees to indemnify and hold harmless the Atlanta Swim School its coaches, officers, directors, agents, and employees against any liability resulting from any injury that may occur to the participant while participating in the Atlanta Swim School swim lesson programs. The participant also agrees to indemnify Atlanta Swim School for any damages incurred arising from any claims, demand, action or cause of action by the participant. Atlanta Swim School assumes no responsibility for any personal property placed in or about the facility.

The parent/guardian/participant authorizes any representative of Atlanta Swim School to have the participant treated in any medical emergency during their participation in the Atlanta Swim School swim lessons or programs. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical crew and transportation for the participant.

I've read the above and agree.

Photos and/or Video

I understand that photos or video are occasionally taken at the Atlanta Swim School and that any photo and/or video taken of me and/or a member of my family, and/or my guest(s) may be used for Atlanta Swim School publicity purposes.

I've read the above and agree.

Registration Fee and Tuition Charges

At the Atlanta Swim School, there is a yearly, non-refundable, administration fee per family, as put forth on the Atlanta Swim School registration form. The fee will be paid on the family's anniversary month each year, while enrolled in swim lessons.

I've read the above and agree.

Payment Policy and Cancellation Policy

All monthly automatic debit transactions will be charged on the 1st of each month.

A $10 (NSF/Bank Fee) charge will be assessed on all declined automatic debit transactions, and returned checks.

If automatic debit transactions are returned three (3) times, your automatic debit privileges will be cancelled.

If paying by check or cash, I realize I must pay for three months in advance.

In order to cancel swim lessons, a completed withdrawal form must be submitted at least 30 days prior to the last lesson. Withdrawal forms can be found at the front desk or online at www.atlantaswimschool.com. Unfortunately, hand written letters or typed emails will not be accepted as a form of cancellation.

All children who are not potty trained, must wear a reusable swim diaper while taking swim lessons at the Atlanta Swim School.

Due to operational costs, NO REFUNDS, CREDITS OR TRANSFERS WILL BE ISSUED at the Atlanta Swim School.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number