Swimming Lesson Consent Form

1
Participant name
First Name
Last Name
2
Phone number
Please enter a valid phone number.
3
Email
example@example.com
4
Birth date
Date
Month
Day
Year
5
Gender
Male
Female
6
Session beginning date and time
Date
Month
Day
Year
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12
Hour
00
01
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59
Minutes
PM
AM
PM
7
How long will you participate in the lessons?
8
Do you have any health issues that we should be aware of?
Yes
No
9
Specify more details about your health condition
10
Your health condition report provided by your doctor
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
Pool equipments checklist
12
By signing below I agree the following
I confirm that all information given above is true.
I understand that during the session, the reaction of my child's body, cannot be predicted with accuracy, thus risks may arise due to adverse changes that may lead to heart attack, high blood pressure, or stroke.
I understand and consent to any emergency medical treatment required during the session.
I understand and agree to abide by all rules and health conditions required for use of the pool.
I understand all needed equipment given above must provide by myself, the pool does not have any authority to provide the needed equipments.
I understand and agree that no recording, filming or photographic equipment including mobile phones with camera facilities are not acceptable to using inside the pool areas.
I understand that only two excused cancellation is going to be permitted for both private and group lessons.
13
Your signature
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