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FILL OUT FORM BEFORE SWIM SESSION APPOINTMENT

SWIM LESSON AUTHORIZATION FORM

(Please fill out, sign, scan, and email the form to tgwclients@gmail.com before your first lesson.)

Please List ALL participants and their ages:

Names

Names

Names

Names

Age

Age

Age

Age

I give permission for my child to swim at the Carolina Lakes Pool and I understand I must be a member to get in or have an authorized pass to enter the community. There is no lifeguard on duty, but my coach is CPR/First Aid Certified. I come at my own risk.

I agree to give 24hrs notice of cancellation or I forfeit my session(s).

I understand my deposit of $30 to hold my child’s spot is non-refundable, and that each week must be paid the Friday before the next week of lessons, or I may lose my spot

I understand lessons may be cancelled in the event of lightning, severe weather, pool closures, or instructor illness. But rescheduling will be made available, or a refund will be issued.

I agree to supply my child with a water bottle, towel, sunscreen, and appropriate goggles (no nose covers or scuba-style goggles.) I understand this is an outdoor community pool and sunburn, heat exhaustion and dehydration are risks for which I do not hold The Genetic Warrior, LLC responsible.

I understand that if my child is showing cold & flu symptoms that I will need to reschedule my lesson(s). Reschedules must be redeemed within 30 days.

I understand that my child can be injured or drown at the pool and will not seek retribution or legal action holding instructor Melody Villavicencio-Guerrero of The Genetic Warrior, LLC responsible in any way

I do not hold The Genetic Warrior, LLC responsible for any lost, stolen, or damaged items left at the pool or in the car, while parked or at the pool in Carolina Lakes. I understand That Genetic Warrior, LLC is not affiliated in any way with Carolina Lakes.

My child does not have any medical conditions or physical limitations that would prevent him/her from participating in swim lessons and is cleared for physical activity.

CHILD 1: NAME

No experience with water

Has been in the water with no formal instruction.

Has taken the following classes

My child is a_______ swimmer

beginner

Intermediate

advance

Does your child usually wear floatation devices while in water? (This would include water wings.)

Yes

No

Does your child have any initial fears of the water? If yes, Please explain:

What are your goals this season in lessons? Is there anything else I need to know while training your child?

CHILD 2: NAME

No experience with water

Has been in the water with no formal instruction.

Has taken the following classes

My child is a_______ swimmer

beginner

Intermediate

advance

Does your child usually wear floatation devices while in water? (This would include water wings.)

Yes

No

Does your child have any initial fears of the water? If yes, Please explain:

What are your goals this season in lessons? Is there anything else I need to know while training your child?

CHILD 3: NAME

No experience with water

Has been in the water with no formal instruction.

Has taken the following classes

My child is a_______ swimmer

beginner

Intermediate

advance

Does your child usually wear floatation devices while in water? (This would include water wings.)

Yes

No

Does your child have any initial fears of the water? If yes, Please explain:

What are your goals this season in lessons? Is there anything else I need to know while training your child?

USE THIS SPACE FOR ANY ADDITIONAL CHILDREN:

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The Genetic Warrior® All Rights Reserved.

Hours of operation

Monday - Friday 9am - 6pm

CLOSED on Thanksgiving, Christmas and New Years Day.

Contact Us

thegeneticwarrior@gmail.com
(919) 867-7644

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