Pool Swim Lesson Staff Use Only Above The Line
Session #1____Time__________Intro-C____Check no__________Check amt__________Lesson
amt____________
Session #1____Time__________Intro-C____Check no__________Check amt__________Lesson
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Session #2____Time__________Intro-C____Check no__________Check amt__________Lesson
amt____________
Session #2____Time__________Intro-C____Check no__________Check amt__________Lesson
amt____________
Session #3____Time__________Intro-C____Check no__________Check amt__________Lesson
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Session #3____Time__________Intro-C____Check no__________Check amt__________Lesson
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CABRILLO SWIM SCHOOL REGISTRATION
Child's Name_______________________________________________Age______________
Parent / Guardian________________________________________Phone________________
Address_____________________________________City_______________Zip___________
Emergency Contact______________________________________Phone_________________
Email_______________________________________________________________________
Circle Desired Pool: APTOS HIGH CABRILLO COLLEGE
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SWIM LESSON CLASSES
--Aptos Classes:
11:00-11:30 11:30-12:00 12:30-1:00
3:00-3:30 3:30-4:00 4:00-4:30 4:30-5:00 5:00-5:30 5:30-6:00
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Cabrillo Classes:
10:30-11:00 11:00-11:30 11:30-12:00
2:00-2:30 2:30-3:00 3:00-3:30
INTRODUCTION TO COMPETITIVE SWIMMING CLASSES
Available Sessions At Each Pool: (all sessions the same as those listed under swim lessons )
Available Class Start Times: (50 minute classes / Mon > Thurs )
APTOS 3:10 - 4:00pm CABRILLO 10:10 - 11:00am
HARBOR 9:10 - 10:00am / 4:10 - 5:00pm
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SELECT A POOL: Aptos__________ Cabrillo__________ Harbor__________
SELECT SESSION(S): Session #1______ Session #2______ Session #3______
SELECT CLASS LEVEL: 1-A______ 1-B______ 2______ 3______ Intro-Comp______
SELECT CLASS START TIME:
1st Choice_______________ 2nd Choice_______________ 3rd Choice______________
Comments:_______________________________________________________________
Cost: $132.00 ( all classes including intro-comp )
Amount of Payment:_________________ checks to 'Cabrillo Swim School'
Send payment and registration form to:
Cabrillo Swim School PO Box 548 Aptos CA 95001
INFO: Jim 688-3613 / 331-1959 willitriplett@aol.com
CABRILLO SWIM SCHOOL WEBSITE: www.cabswimschool.com
CABRILLO SWIM SCHOOL
WAIVER/RELEASE OF LIABILITY
I, _______________________, the enrolled participant and or the parent/ guardian of the participant agree &
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 & death.
The participant hereby agrees to participate in the (program) & hereby agrees to indemnify & hold harmless
(Swim School), it’s instructors, officers, directors, agents, & employees against any liability resulting from injury
that may occur to the participant while participating in (program). The participant also agrees to indemnify (Swim
School) for any damages incurred arising from any claims, demand, action or cause of action by participant.
The participant authorizes any reprehensive of (Swim School) to have the participant treated in any medical
emergency during their participation in (program). Further, the participant and/or parent/guardian agrees to pay
all costs associated with medical care & transportation for the participant.
I have noted on the back of this form any medical/health problems of which the staff should be aware.
I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS
CONTENTS AND SIGNIFICANCE.
SIGNED:_________________________ Date:_____________________
(participant or parent/guardian)
SIGNED:_________________________ Date:_____________________
(participant or parent/guardian)