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 Parent's Information
Form No. : 3041

 Participant's Information

 Participant 1

CONSENT AND WAIVER/RELEASE OF LIABILITY
PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY & WAIVER OF CERTAIN LEGAL RIGHTS.
Full payment is due prior to your child's first lesson. Cash, check, or credit cards (through Paypal or Square) are accepted as payment. Checks should be made payable to My Little Swimmer and mailed to My Little Swimmer, 5654 Oakdale Avenue, Woodland Hills, CA. 91367.
The undersigned agrees to defend, pay and save free and harmless My Little Swimmer, Inc. Swim School, the facility owners where lessons are conducted and their respective agents, employees' actions, judgments and proceedings of any kind or in favor of anyone whomsoever and from and against all injury or property damage arising directly or indirectly out of, from or on account of applicant's presence at or use of the facilities or participation in any activities or programs applied for hereby or at any time hereafter.
My child (children) has been examined by a certified physician within the last year and is physically fit and free from any contagious diseases to participate in swim lessons.
I understand missed classes may not be carried over to the next session. I understand that My Little Swimmer is unable to grant refunds once your child's first class begins. We reserve the right to: accept only those families who abide by our nurturing child-centered philosophy; to expel those families that do not abide by the philosophy, fail to follow rules, or are disrespectful to teachers, staff or fellow classmates.
Please be sure to bring the following items to each class: Bathing suit, swim diaper (if needed), at least one towel, and dry clothes to change out of wet swim clothes.
Play equipment in the waiting areas, such as the swing set, zip-line, and outdoor toys used by the student(s) or sibling(s) prior, during, or after lessons may be used at your own risk and need to be supervised by an adult at all times.
I/We the parent(s) permit the participant(s) listed below to participate in all swim lesson activities. I/We 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 swimming activities at My Little Swimmer Swim School and hereby waive, releases, absolve, indemnify and agree to hold harmless the My Little Swimmer Swim lesson program, the owners, the instructors, the management, directors, agents, facility owners and employees for any claim ing in injury to the below named child(ren). The participant(s) also agrees to indemnify the My Little Swimmer Swim School for any damages incurred arising from any claims, demand, action or cause of action by the participant. (Initials).
I/We hereby grant permission and authorize any representative of My Little Swimmer Swim School to have the participant(s) treated in any medical emergency during their participation in the My Little Swimmer swim lesson program. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant. (Initials).
CONSENT FOR EMERGENCY MEDICAL TREATMENT
In the event of a medical emergency, the undersigned Parent/Guardian of the participants listed below, hereby grants authorization to the My Little Swimmer Swim School and its representatives, to employ any legally licensed physician, hospital or health care facility on behalf of each of the undersigned, and to direct and/or order emergency medical treatment for the participants named below. Each of the undersigned also agree that neither the My Little Swimmer Swim School nor any of its representatives shall be liable under any circumstances to anyone for exercising the foregoing authority in the event of an emergency. (Initials)
PROMOTIONAL MATERIAL
I understand that photos and video are occasionally taken at the My Little Swimmer Swim School for promotional and marketing purposes. I agree that any photo or video taken by the My Little Swimmer Swim School of my child(ren) may be used in the My Little Swimmer Swim School's promotional and marketing materials. (Initials)
I HAVE CAREFULLY READ THE ABOVE INFORMATION, SIGNED AND INITIALED IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE. THE ELECTRONIC SIGNATURE BELOW CONSTITUTES AND VERIFIES MY ACCEPTANCE AUTHORIZATION OF ALL TERMS HEREIN.

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MY LITTLE SWIMMER
5654 OAKDALE AVENUE
WOODLAND HILLS, CA 91367

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