Student Sign Up Form

***PAYMENT, MAKEUP AND REFUND POLICY PLEASE READ CAREFULLY ***

Initial Program (6 week session) $675 at AquaChild. $1250 for Private lessons.
If your child requires additional instruction beyond the 6 week session, the rate will be $112.50 per week at AquaChild. $200 per week for Private lessons.

Makeup days can not be used for additional weeks needed.

We require at least three day's notice prior to the start date for a refund. You must call at least by the Friday prior to your start date if you wish to cancel, be taken off the schedule completely, and receive a refund.

If your child cannot start because of an illness on the date scheduled payment has been applied, a time slot has been reserved for your child, and a refund will not be given. Those days will be considered makeup classes which can be scheduled after completion of the initial program.

Payment is applied regardless of a leave of absence during the child’s 6 week session. Your child is scheduled for a 6 week session, it is expected that he/she will attend all sessions in a timely manner.

Disregarding the schedule for your child will only prolong his/her learning development. Missed lessons within the 6 week session can be made up after completion of program only when they fit the following criteria:

• Missed sick days - Doctor’s Note required.
• Temporary closure for pool treatment due to diaper accident.
• Religious and Federal Holidays.
• Unsafe weather conditions.

Makeups must be used during the season in which your child completed the program. Make ups are done on available basis during the months of September-December. Please call to schedule.

A leave of Absence, such as vacation, or a change in personal schedule does not qualify for make-up days. Please speak to the office manager or Instructor if youany further questions regarding our make-up policy.

Unless notified, please attend class during seemingly bad weather. We will do our best to contact parents when classes are cancelled. We do hold classes during rain, unless we see lightning. If you're unsure about a cancellation, please call the office at (305) 354-8306.

*Indicates required field

Parents Information
Parent Name:
Email:
Phone:
Cell:
Parent Name:
Email:
Phone:
Cell:
Schedule Information
Confirmed Date:	(MM/DD/YYYY - 01/01/2011)
Confirmed Time:	select 07:00AM 07:10AM 07:20AM 07:30AM 07:40AM 07:50AM 08:00AM 08:10AM 08:20AM 08:30AM 08:40AM 08:50AM 09:00AM 09:10AM 09:20AM 09:30AM 09:40AM 09:50AM 10:00AM 10:10AM 10:20AM 10:30AM 10:40AM 10:50AM 11:00AM 11:10AM 11:20AM 11:30AM 11:40AM 11:50AM 12:00PM 12:10PM 12:20PM 12:30PM 12:40PM 12:50PM 01:00PM 01:10PM 01:20PM 01:30PM 01:40PM 01:50PM 02:00PM 02:10PM 02:20PM 02:30PM 02:40PM 02:50PM 03:00PM 03:10PM 03:20PM 03:30PM 03:40PM 03:50PM 04:00PM 04:10PM 04:20PM 04:30PM 04:40PM 04:50PM 05:00PM 05:10PM 05:20PM 05:30PM 05:40PM 05:50PM 06:00PM 06:10PM 06:20PM 06:30PM 06:40PM 06:50PM 07:00PM 07:10PM 07:20PM 07:30PM 07:40PM 07:50PM 08:00PM
Student Information
If you have more than one child to register, please fill out a separate registration form for each.
Student Name:
Address1:
Address2:
City:
State:	Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington, DC Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip:
Age:	(5 mon old, 1 year old, 5 years old)
D.O.B:	(MM/DD/YYYY - 01/01/2011)
Gender:	select one Female Male
Pediatric:
Phone:
Physician:
Phone:
Medical Condition:
Additional Information
Any comments or additional information you would like us to know:
Coupons & Offers
Do you have any?	select Living Social Amazon Deal Groupon Auction Certificate Other
If selected other:
Certificate number:
How did you hear about AquaChild?
Select one:
If other:
Terms & Conditions
I give my child the permission to participate in aquatic activities at Aquachild. My child is in good health and physical condition, and is not suffering from any conditions that would prevent him/her from engaging in the activities at Aquachild. I have also read and understand the Makeup, Payment, and Refund Policy.
Agreed:
Photos & Videos
Photographs and videos may be taken in conjunction with the lessons; I understand and agree that they may be used for informational and advertising purposes, and are available for purchase at our photo kiosk.
Agree: *	Yes No
Signature:	Enter your full name
Security: *	Type the characters you see in the picture below.

Lessons start on time. Please make sure your child is dressed and ready to swim at scheduled time to ensure they don't miss their lesson.
Payment is applied regardless of a leave of absence during the child’s 6 week session. Your child is scheduled for a 6 week session, it is expected that he/she will attend all sessions in a timely manner.