Enrollment Student's Name* First Last Student 2's Name* First Last Student 3's Name* First Last Student 4's Name* First Last Birthdate* Date Format: MM slash DD slash YYYY Age in Months*Student 2 Age in Months*Student 3 Age in Months*Student 4 Age in Months*Student 3's Birthdate* Date Format: MM slash DD slash YYYY Student 4's Birthdate* Date Format: MM slash DD slash YYYY More than 1 student? 1 2 3 Pool Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Swimming Lesson DetailsRequested Start Date* Date Format: MM slash DD slash YYYY Registration Fee $40 per Student# of lessons*Best Days & Times for LessonsType of Lesson*GroupIndividualParent / GuardianPlease Acknowledge Terms / Conditions* The parent / guardian listed below agrees to these terms / conditions. TERMS I understand that I will be billed at the beginning of each week and payment is due at the first lesson. I am returning this agreement with the deposit set out above and I understand that this amount is to be credited on the first tuition bill. If registration is canceled by me, this sum is forfeited. I agree to the “conditions of enrollment” contained in this agreement and I agree to pay the total of the charges indicated above at the times stated. I understand that Making Waves will schedule its instructors according to this Agreement and that no deductions will be made for absence or withdrawal. CONDITIONS OF ENROLLMENT FOR CURRENT SESSION AND ALL SUBSEQUENT SESSIONS Parent’s permission for swimming instruction. I give permission for my child(ren): To receive group or individual swimming instruction from Making Waves. To be taught with various aids of instruction including dive rings, kickboards, sponge balls, toys, etc. Parent’s agreement to be present during instruction. Parent acknowledges that Making Waves is a swim instruction service focused solely on teaching swimming skills. Parent agrees that at all times during swim instruction Parent will continue supervision of his or her child(ren) either by their direct presence at the pool or by delegating the responsibility for direct supervision to someone other than the Making Waves swim instructor. Parent’s agreement that Making Waves is not liable for pool area. Parent agrees that the pool in which instruction is to occur is not owned, leased or maintained by Making Waves. Parent releases Making Waves and its individual instructors from any and all liability for the state of repair of the pool used for instruction, the condition of the premises around the pool, and the physical area in which Parent’s child(ren) is to be instructed. Name* First Last Today's Date* Date Format: MM slash DD slash YYYY Primary Phone*Secondary PhoneEmail*