Sign Up – Swim By Natalie

How many swimmers are signing up today?*

(Not including parents in Mommy and Me packages.)

1

2

3

Swimmer #1

Swimmer's Name*

Date of Birth*

Gender*

Male

Female

Other / Non-Binary

Select a swim package:*

Private Lessons (Pack of 10) – $800

Semi-Private Lessons (Pack of 10) – $600

Mommy and Me (Pack of 10) – $500

Grown-Up Lessons (Pack of 10) – $1300

Swimmer #2

Swimmer's Name*

Date of Birth*

Gender*

Male

Female

Other / Non-Binary

Select a swim package:*

Private Lessons (Pack of 10) – $800

Semi-Private Lessons (Pack of 10) – $600

Mommy and Me (Pack of 10) – $500

Grown-Up Lessons (Pack of 10) – $1300

Swimmer #3

Swimmer's Name*

Date of Birth*

Gender*

Male

Female

Other / Non-Binary

Select a swim package:*

Private Lessons (Pack of 10) – $800

Semi-Private Lessons (Pack of 10) – $600

Mommy and Me (Pack of 10) – $500

Grown-Up Lessons (Pack of 10) – $1300

Subtotal

Parent Info

Parent's Name*

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Email*

Emergency Contact Info

Contact Name*

Relation*

Phone*

Is there any medical history (allergies, learning disability, etc.) that we should be aware of or that would help in working with your child(ren)?

WAIVER/RELEASE OF LIABILITY

PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.

I,

Your Name*

,the enrolled participant and/or the parent/guardian of the participant 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 swimming lessons and hereby agrees to indemnify and hold harmless Swim by Natalie, Natalie Rones, Jaden Rones coaches, agents, against any liability resulting from any injury that may occur to the participant while participating in the lessons. The participant also agrees to indemnify Swim by Natalie, Natalie Rones for any damage incurred arising from any claims, demand, action or cause of action by the participant.

The participant authorizes any representative of Swim by Natalie to have the participant treated in any medical emergency during his/ her participation in the swimming lessons. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and transportation for the participant.

I have noted on the registration form any medical/health problems of which we should be aware.

All Swim by Natalie students, siblings, parents, and anyone attending lessons agree to stay in the designated area.

CANCELLATIONS: I agree to give 24 hours notice or the class is lost. Make ups will take place during the next session, or during the week in the evenings.

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGNED IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.

Signature*

Date*

PRECAUTIONARY COVID-19 LIABILITY RELEASE

Due to the outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitization and disinfecting practices. Please complete the following and sign below. A detailed description of safer facility practices can be found a on our website as well as on the parent portal home screen.

Symptoms of COVID-19 include:

• Fever

• Fatigue

• Dry cough

• Difficulty breathing

Swim By Natalie has put in place preventative measures to reduce the spread of COVID-19; however, Swim By Natalie cannot guarantee that you or your child(ren) will not become infected with COVID-19. As with every other activity, there could be an increase in your risk and in your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Swim By Natalie and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Swim By Natalie may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Swim By Natalie employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Swim By Natalie or participation in Swim By Natalie programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Swim By Natalie, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Swim By Natalie, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in Swim By Natalie program.

I the undersigned, agree to the following:

• I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.

• For the safety of our staff and swimmers, any person with a temperature above 100.4 are to be sent home until they have no fever and no evidence of COVID-19 symptoms for 72 hours.

• I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 14 days.

• I affirm that I, as well as all household members have not been knowingly exposed to anyone diagnosed with COVID-19 in the last 14 days.

• I affirm that I, as well as all household members, have not traveled outside of the country or to any city other than our own that is or has been considered a “hot spot” for COVID-19 infections within the last 14 days

• I understand that this business cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.

• I understand that in order to observe social distancing, only 2 observer per family will be allowed in the facility.By signing below, I agree to each above statement and release Swim By Natalie and its staff, owners, officers, and personnel, from any and all liability for the unintentional exposure or harm due to COVID-19. I also confirm that all information regarding my health and health history is represented as accurate and truthful. Finally, if any of the aforementioned changes throughout the course of my attendance at Swim By Natalie, I will be held liable for notifying Swim By Natalie staff of these changes and I am responsible for continuing adhere to the COVID-19 safety policy, even if this means a forfeiture of my or my swimmers lessons.

Signature*

Date*

Checkout

Total

Please send the above total using one of the following methods:

Venmo: @Natalie-Rones
Zelle: 8584141129