Registration Form

To register for classes, please complete the electronic form below. You may also download a copy of the form for your records (located below the registration form).

Aqua Sports Swim Academy

Student's Name (Click the "+" sign to add additional children)*
First Last Male or Female Birthdate (mm/dd/yyyy)
Parent's Name
First Last
Best Daytime Phone*
Home Phone
Email*
Address*
Street Address Address Line 2 City State
Swim Lesson Pricing
1 SESSION PRIVATE (1:1 student/teacher ratio) which is 8 x 25 minute lessons - $520.00
1 SESSION SEMI PRIVATE (2:1 student/teacher ratio) which is 8 x 25 minute lessons - $360.00 per child
* Credit Card payment option available with 4% fee added for merchant processing
The following are a few important guidelines about our swim program:
1) We request payment in full for each reserved and confirmed session ON or PRIOR to the first scheduled lesson. Along with payment, please include corresponding SESSION number and each student’s name as submitted on the registration form. Invoices will be sent shortly after we receive an email confirmation. ** 5% late fee added to payments 30 days overdue
2) Changes: Aqua Sports allows for two scheduled lessons to be changed PER SESSION of eight lessons. Advance notice must be provided to the office at least one hour before the lesson start time. The first rescheduled lesson is complimentary. An administrative change fee of $15.00 per student will be assessed for the second schedule change.
3) Renewals: Our lessons do not automatically renew so we ask that you inform Aqua Sports in writing, one week prior to the last lesson of the current SESSION that you would like to renew student for another SESSION. Aqua Sports assists the renewal process by emailing a reminder with proposed lesson dates and times for a new session. A reply to the reminder email serves as written confirmation. Invoices will be sent shortly after we receive email confirmation. To ensure a preferred time slot, please renew prior to the last lesson in the current session. Payment will also need to be current on any completed SESSIONS in order to request and confirm renewal of an additional session.

5% late fee added to payments not received within thirty days of due date.
We ask that a parent or guardian agrees to remain on the premises during the swim lesson. Any medical attention needed by the student will be the responsibility of the attending parent or guardian. Children and siblings will be supervised by a parent or guardian at all times when not in class. Children not participating in a swim class must be out of the pool while lessons are in progress.
Consent:
Type Name of Parent or Legal Guardian*
I have read and acknowledged the consent form above.*
- Yes
POLICIES

Please initial each item below. Your initial indicates that you and/or the student’s guardian have read each policy and will agree to each policy
Swim Lesson Scheduling and Confirmation
Scheduling is conducted during Office Hours which are Monday through Friday, 9:00 am to 4:30 pm. Our office is closed on major Holidays when no lessons are scheduled. Please see our calendar tab for an updated annual calendar with important dates. (Initial the box below.)*
Swim lessons are scheduled in packages of eight and referred to as a SESSION. Each SESSION contains 8 x 25 minute lessons that are typically scheduled one lesson per week for eight continuous weeks. (Initial the box below.)*
Aqua Sports requires each registrant to confirm all dates in a SESSION. If confirmation is not received prior to the SESSION'S first lesson, no lessons will be scheduled. (Initial the box below.)*
For SEMI PRIVATE SESSIONs, it is the responsibility of the registrant to identify their swim partner. The swim partner must also provide Aqua Sports with registration and contact information. BOTH partners must agree and confirm all lesson dates for the SESSION prior to the first scheduled lesson. (Initial the box below.)*
Instructor requests are always welcomed, but not guaranteed. Due to certain circumstances, there may be occasions when instructors will not teach on their scheduled days. In order to maintain continuity in the schedule, Aqua Sports reserves the right to have other instructors fill in as necessary. (Initial the box below.)*
Payments, Credits and Refunds
Payment for each SESSION is due, in full, on or PRIOR to the first scheduled lesson. (Initial the box below.)*
A credit towards the cost of any program offered by Aqua Sports may be issued in the event of an injury which causes a child to remain out of the water for a sustained period of time (a minimum of two full weeks). A doctor’s note may be required to validate the medical reason for not swimming.(Initial the box below.)*
No refunds will be issued on or after SESSION dates have been confirmed. Full payment amount remains due regardless of attendance. (Initial the box below.)*
During Swim Lesson Time
Any child that is not toilet trained is required to wear a swim diaper and plastic pants underneath their swim suit. (Initial the box below.)*
Swim lessons are scheduled to begin at the top and bottom of the hour. It is important for students to arrive on time for their lessons. In the event of delayed arrival in excess of ten minutes, the swim lesson will not be taught. (Initial the box below.)*
For safety reasons, students are not allowed to enter the pool before class, and are not permitted to stay in the pool after the instructor has dismissed the class. There is NO LIFEGUARD ON DUTY. (Initial the box below.)*
Session Renewals
Aqua Sports Swim Academy will not automatically renew additional SESSIONS. If a student intends to sign on for another session, Aqua Sports must be informed via email one full calendar week prior to the last lesson of the current SESSION. Confirmation will be required by each registrant.(Initial the box below.)*
Payment should be current on any completed or in progress SESSION in order to renew additional SESSIONS. Untimely payment could result in the loss of a preferred time slot. (Initial the box below.)*
Schedule Changes
Aqua Sports allows for two scheduled lessons to be changed PER SESSION of eight lessons. Advance notice must be provided to the office at least one hour before the lesson start time. The lesson to be changed will be added to the end of current session or, may be scheduled at a different time, when space is available. Requests for changes must be done in writing, via email. (Initial the box below.)*
• The first rescheduled lesson is complimentary. An administrative change fee of $15.00 per student will be assessed for the second schedule change. Requests for lesson changes beyond two will not be honored.*
• In the case of a SEMI PRIVATE lesson, both students will need to make the schedule change. If one partner of a SEMI PRIVATE lesson misses a lesson with advance notification to Aqua Sports, the other partner can swim in the scheduled lesson time, however, the partner unable to swim will not be eligible for a schedule change.*
• If a permanent day and/or time change is requested and available, the new time slot will be in addition to any current, confirmed lessons.*
All prices and policies are subject to change without notice. (Initial the box below.)*
Type Name of Participant, or, if under 18 years of age, Parent or Legal Guardian*
I have read and acknowledged the "Policies" form above.*
- Yes
WAIVER/RELEASE OF LIABILITY
PLEASE READ CAREFULLY BEFORE SIGNING.
THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.
I, (Enter full name in box below.)*

the enrolled participant and/or the parent/guardian of the participant (if the participant is under 18 years of age) 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 swim lesson and hereby agrees to indemnify and hold harmless Aqua Sports Swim Academy, its coaches, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in swim lessons. The participant also agrees to indemnify Aqua Sports Swim Academy for any damages incurred arising from any claims, demand, action or cause of action by the participant.
The participant and/or the parent/guardian of the participant, authorizes any representative of Aqua Sports Swim Academy to have the participant treated in any medical emergency during their participation in swim lesson. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.
Type Name of Parent or Legal Guardian*
I have read and acknowledged the "Waiver/Release of Liability" form above.*
- Yes
STUDENT/PARENT CONDUCT EXPECTATIONS
• For safety reasons, students are not allowed to enter the pool before class, and are not permitted to stay in the pool after the instructor has dismissed the class. There is NO LIFEGUARD ON DUTY.
• A Semi private lesson may be taught in a split class if the instructor determines the separation is in the best interests of the students.
• It is the responsibility of the parent or guardian to notify the instructor of any relevant and pertinent medical circumstances, learning disabilities, or water experiences BEFORE the first class begins.
• In the unfortunate instance of a student defecating in the pool it is critical that the staff be notified immediately. After the first occurrence, the student (regardless of age) is required to wear both a disposable swim diaper and plastic/vinyl cover under their swimwear. Multiple incidents will result in suspension from Aqua Sports Swim Academy. A mandatory temporary pool closure (anywhere from 1 hour up to 24 hours, depending on the circumstance) will be required by the Center for Disease Control.
• Parents/guardians should encourage their children to use the restroom before class. The parent/guardian will need to be available to take the child to the restroom during class in the event that this becomes necessary.
• Parents/guardians may observe the class, but it will be at the discretion of an instructor to recommend that a parent/guardian leave their child’s sight in order to limit distractions, and help to build the child’s trust with their instructor.
• Aqua Sports Swim Academy strives to keep a safe, family-friendly environment. In the circumstance that management feels an individual is endangering others, demonstrating inappropriate behavior, abusing the facility, or becoming aggressive toward a staff member or another customer, that individual will be asked to leave the facility and their registration will be terminated.
• Aqua Sports respectfully requests that any concerns, questions, or comments to be addressed with an instructor are done prior to or at the end of a lesson. If necessary, a request can be placed with the business office for an opportunity to schedule time with the instructor. We will do our best to facilitate a meeting in a timely manner.
I have read and acknowledged the "Student/Parent Conduct Expectations" form above.*
- Yes
Preferred Day(s) (Please select all that are possible for you.)*
Preferred Times:*
Preferred Swim Instructor:*
How did you hear about us?*
- A Friend/Word of Mouth
- Newspaper
- Local School
- Parenting on the Peninsula Magazine
- Facebook
- Other
Please let us know if there any special needs, medical/health problems, and/or requests for your child that the staff should be aware. **Please also include any previous swim experiences, or lack thereof, relevant to your swim lesson needs.
PLEASE READ
By clicking the button below, you are confirming that you have read and acknowledged our Waiver/Release, Policies and Student/Parent Conduct Expectations forms.
Your form will not be submitted until you click the blue button below.

Click here to download the Aqua Sports Swim Academy Registration Form

NOTE: You need Adobe® Acrobat Reader to view and print the registration forms.

If you have any questions about these forms, please call (650) 554-1340 or email lessons@aquasportsswimacademy.com

Send Payments to:
Aqua Sports Swim Academy
212 North San Mateo Drive, Suite 3
San Mateo, CA 94401

Navigation

Registration Form

Aqua Sports Swim Academy

Swim Lesson Pricing

POLICIES

Swim Lesson Scheduling and Confirmation

Payments, Credits and Refunds

During Swim Lesson Time

Session Renewals

Schedule Changes

WAIVER/RELEASE OF LIABILITY

STUDENT/PARENT CONDUCT EXPECTATIONS

PLEASE READ

LATEST NEWS

Now Hiring!

Now Scheduling!

OUR TEAM

First	Last	Male or Female	Birthdate (mm/dd/yyyy)