Parent - Guardian
              
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                    First Name 
                   
                
                
                  
                     
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
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              Mobile phone
              
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              Address
              
             
          
                
                
                  
                     
                    Address 1 
                   
                
                
                  
                     
                    Address 2 
                   
                
                
                  
                     
                    City 
                   
                
                
                  
                     
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              Student Info
              
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                    First Name 
                   
                
                
                  
                     
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Birthdate
              
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                    MM 
                   
                
                
                  
                     
                    DD 
                   
                
                
                  
                     
                    YYYY 
                   
                
               
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Select lesson time(s) $100 each - Want four or more? Save with one of our lesson packages.
              
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                  Sat Nov 18 9:00-9:25
                
                  Sat Dec 2 10:30-10:55
                
                  Sat Dec 9 10:30-10:55
                
                  Sat Dec 16 10:00-10:25
                
                  Sat Dec 16 10:30-10:55
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Waiver and release of liability
              
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                I, being the parent/legal guardian of the child named above (the "Student"), on behalf of myself and the Student, voluntarily consent to have the Student attend and participate in Glide Swim School LLC ("Glide") swimming lessons. I am aware of the risks to person and property known to be associated with swimming lessons and domestic swimming facilities including, but not limited to, the dwelling structure, the pool, gates, diving board, steps, equipment, foliage, insects, parking and surrounding areas. I understand that swimming is a potentially hazardous activity and there are risks inherent to swimming that include but are not limited to: injuries, broken limbs, cuts, paralysis, illness and even death. Knowing the risks, and in consideration of the Student participating in swim lessons, I hereby agree to assume all risks related to such participation and hereby further release and agree to indemnify and hold harmless Glide Swim School LLC and its coaches, owners, officers, agents and employees from any and all liabilities, claims, demands and causes of action whatsoever arising from, relating to or attributable to any loss, damage or injury, including death, that may be sustained or suffered by Student while participating in, or traveling to or from, swim lessons— including any such liabilities, claims, demands or causes of action arising out of Glide Swim School or its instructors' negligence or gross negligence. I agree to indemnify and hold harmless Glide and its coaches, owners, officers, agents and employees from and against any and all damages, costs and expenses (including, but not limited to, costs of any treatment or medical care, reasonable attorneys' fees and court costs) incurred by them arising from any claims, demands or causes of action by or on behalf of the Student (including any claims, demands or causes of action arising out of Glide's or its instructors' negligence or gross negligence).  I hereby authorize any representative of Glide to have the Student treated in any medical emergency during his or her participation in swim lessons. Further, I hereby agree to pay all costs associated with medical care and transportation for the Student in connection with any medical emergency.  I acknowledge that I have thoroughly read this waiver and release and fully understand that is a release of liability. By signing this document, I am waiving any right I or my successors might have to bring a legal action or assert a claim for and on behalf of myself or the Student against Glide Swim School LLC as detailed in the first paragraph of this Waiver and Release.
                
                  Acknowledged, authorized, and agreed
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Photo & video authorization
              
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                I authorize Glide Swim School to use photographs and/or video taken of my child(ren) during their swim instruction for use in Glide Swim School training, advertising, and marketing materials including Glide's social media, website, and printed materials.
                
                  Yes, I agree
                
                  No, I disagree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Policies and Special Notes
              
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                Lesson plans are invoiced fully in advance and payment is due upon receipt. Lesson plans renew monthly at the initially agreed rate unless cancellation is confirmed in writing at least 14 days prior to the next monthly renewal.  Glide Swim School reserves the right to cancel all, or any portion of, a swim lesson due to weather, acts of God, or any other reasons within or beyond its control. Lessons cancelled by Glide Swim School will be rescheduled at our mutual convenience.  Any cancellation made by students or guardians fewer than 24 hours prior the start of the scheduled swim lesson will be charged as a completed lesson without rescheduling, refund, or other recompense.
                
                  Acknowledged, authorized, and agreed