Infant Registration - Elite Swim Academy

Guardian & me Registration

Parent/Guardian Name

First

Last

Phone

Emergency Phone Numbers (if different from Parent)

Swimmer's Name

First

Last

Date of Birth

Gender

Learning/Physical Needs:

Very important for our instructors to know if a child has ADHD, sensory processing needs, or physical disabilities that require extra attention

Select Session

MONDAY: Jul 6, 13, 20, 27 • Aug 3, 10, 17
TUESDAY: Jul 7, 14, 21, 28 • Aug 4, 11, 18
WEDNESDAY 11:00 AM and : Jul 8, 15, 22, 29 • Aug 5, 12, 19
THURSDAY 11:00 AM - 11:45 AM: Jul 9, 16, 23, 30 • Aug 6, 13, 20
FRIDAY 11:00 AM - 11:45 AM: Jul 10, 17, 24, 31 • Aug 7, 14, 21

Multiple Items

Full Payment
50% Nonrefundable Downpayment

Credit/debit Card

Card

Name on Card

Coupon

Total

Item Quantity Qty Total

There are no products selected.

Select Session - MONDAY: Jul 6, 13, 20, 27 • Aug 3, 10, 17 1 $0.00

Select Session - TUESDAY: Jul 7, 14, 21, 28 • Aug 4, 11, 18 1 $0.00

Select Session - WEDNESDAY 11:00 AM and : Jul 8, 15, 22, 29 • Aug 5, 12, 19 1 $0.00

Select Session - THURSDAY 11:00 AM - 11:45 AM: Jul 9, 16, 23, 30 • Aug 6, 13, 20 1 $0.00

Select Session - FRIDAY 11:00 AM - 11:45 AM: Jul 10, 17, 24, 31 • Aug 7, 14, 21 1 $0.00

Multiple Items - Full Payment 1 $360.00

Multiple Items - 50% Nonrefundable Downpayment 1 $180.00

Subtotal

Total $0.00

Consent Level: from

Media Use Consent & Release

Yes, I opt in. I authorize the use of my student's image and likeness as described
No, I opt out. I request that my student's image or likeness not be used

Please read the following information regarding the use of photography, audio, and video recording during our swim sessions. By opting in, you allow Elite Swim Academy to use photographs, video footage, or audio recordings featuring your student for promotional materials, social media, our website, and future marketing campaigns. We promise to always use these materials respectfully and professionally.

I consent

to the Terms & Conditions

Guardian & me Registration

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