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Blue Dolphin Registration

Family Information

Your Name:  Your Address:

City:   State:   Zip:  

Main Phone Number: Include Area Code (Please include hyphens)

Secondary Phone Number: *Very Important

email:

Secondary email:

How did you hear about us?      

Referred by: __________________________________________________________________________________________________________

Student Information
Enroll one student per submission.
for each individual student.

Student Name:     

Date of Birth:

New Student  Returning Student  Adult Lesson  Adult Fitness 
(New Students are required to prepay for lessons 2X week for 2 back-to-back months.)

($50 One-time registration fee)
($10 Returning Family Fee)



Any Medical Concerns and/or Special Needs (please be specific)::

Additional Information about this swimmer:



Lesson Days and Times
Our Lesson are created to meet your needs. Simply decide what time(s) and day(s) you desire.
We will call you to arrange the best available lesson time for you within that time block.
Morning (9 a.m.-Noon)    Afternoon (Noon-5 p.m.)    Evening (5 p.m.- 8 p.m.)

New students must attend 2X per week for the first 2 months.
Returning students may choose to attend 1X or 2X per week.
__________________________________________________________________________________________________________

Time:  Day(s):  Lessons per Week:  Start Month:

Windows Users: Hold down "control" key to select multiple items.   Mac Users: Hold down "Command" key to select multiple items. __________________________________________________________________________________________________________

Please complete the following
In order for your registration to be accepted these must be completed.


Waiver/Release of Liability
Please read carefully before accepting.
This is a release of liability and waiver of certain legal rights.
I have carefully read this LIABILITY RELEASE and consent to full knowledge of its contents and significance.
I the enrolled participant and
/or the parent/guardian of the participant 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 swimming lessons and hereby agrees to indemnify and hold harmless Blue Dolphin 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 swimming lessons. The participant also agrees to indemnify Blue Dolphin Swim School for any damages incurred arising from any claims, demands, action or cause of action of the participant.
The Participant authorizes any representative of Blue Dolphin Swim School to have the participant treated in any medical emergency during their participation in swimming lessons. Further, the participant and or parent guardian agrees to pay all costs associated with medical care and transportation for the participant.
I have noted on this form any medical health problems of which the staff should be aware.

Payment Policy
Please read carefully before accepting.
One-Time Credit Card Payment Only
I authorize B.D.S.S. to make a one-time charge to my credit card to cover my student's initial 2-months of tuition and, if applicable, the new family one time registration fee. Subsequent monthly tuition payments must be in cash or check unless other arrangements have been made with us.
  I understand a $10 late-fee will be assessed for tuition payments received after the 15th of any month.  Declined Credit Card payments may be charged a processing fee of $25 by our Credit Card Processing Company.


Credit Cards VISA and Master Card accepted. Credit card information will be collected VIA telephone during confirmation call.

Cancellation Policy
Please read carefully before accepting.
I understand that after registration is finalized with our office I am in a continual lesson and am responsible to make monthly tuition payments until I provide Blue Dolphin Swim School a 30-day written notice of cancellation by e-mail. or to go from 2 lessons per week to 1 lesson per week.
If lessons are discontinued a $10 re-registration fee will be assessed when lessons are resumed.

Policy Agreement
Please read carefully before accepting.   Policies
I have carefully read the B.D.S.S. Policies and agree to abide by its contents.

Submit registration for one student at a time.
You may then use the browser's BACK ARROW to enroll additional students without re-entering family info.


 
Thank You!
We will contact you by telephone to select your exact lesson time
and to finalize your registration by credit card.

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