Swim Lessons

Name *

First Name

Last Name

Cell # *

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Alternate Phone

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

Please give student's date of birth.

MM

DD

YYYY

Date of Birth

Date of Birth

MM

DD

YYYY

Date of Birth

MM

DD

YYYY

Missed Lesson make up policy *

We will allow 2 make ups through the 9 weeks. You MUST have called at least 24 hours prior to the lesson cancelled. Make ups will be scheduled on case by case manner. Make up classes will be scheduled with your child’s instructor if possible, however this is no guarantee. A no show for class will not be eligible for make up.

I agree

Photo Release *

I agree that any pictures / videos taken during swim lessons can be used for promotions, training, or advertisements by Terri's Swim Academy.

I agree

Terri's Swim Academy rules and regulations. *

I agree

TSA Waiver *

WAIVER/RELEASE OF LIABILITY PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. I, the undersigned participant and parent request voluntary participation for a minor to participate in the events which are herein after referred to as the “activities” sponsored by Terri’s Swim Academy aka TSA . 2024 I agree that this Wavier and Release is signed by me on behalf of all minor children of which I am the parent or guardian, and on behalf of all adults included in my family membership, my guests or anyone gaining entrance to the pool through the use of my membership. I further consent to my/minor’s participation in the activities and acknowledge that the minor and I fully understand my/minor’s participation may involve risk of serious injury or death, including losses which may result not only from my/minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity coordinators and event staff, before I sign this document and before any activities begins. Release – Minor’s Rights: In consideration of allowing Minor Participant to participate in the activities, I hereby release and hold harmless Terri’s Swim Academy, the owners, coaches, employees, volunteers, and other participants (collectively, the “Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that Minor Participant may have or sustain with respect to any and all damage and/or injury, of any type, arising out of his or her participating in the activities. Release – Parents’/Guardians’ Rights: In consideration of allowing Minor Participant to participate in this event, I hereby release and hold harmless the Released Parties, of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that I may have or sustain with respect to any and all damage and/or injury, of any type, arising from Minor Participant’s participation in the activities. I certify that my/minor is in good health and have no physical condition that would prevent participation in activities at TSA. Furthermore, I agree to use my/minor’s personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required. Indemnification by Parent/Guardian: The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages and liabilities for indemnities, contribution or otherwise with respect to any damage and/or injury, of any type, arising from Minor Participant’s participation in the activities. The undersigned also agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Release and is intended to be as broad and inclusive as is permitted by the laws of the State of Louisiana. I further grant permission for Terri's Swim Academy to use my(or my child's) photo or video for promotional purposes. This waiver and agreement shall be valid for one year from the date of signing. Parents must sign for children under 18. As legal parent or guardian of this participant, I hereby verify by my signature that I fully understand and accept the above conditions for permitting my child to participate in any and all swim related activities at Terri's Swim Academy.

I agree