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Welcome to the Team!

We're happy you're here.  Please fill out the registration before starting your lessons.  A PDF is available to download and print/email.

If you are an adult swimmer, please complete this registration.

Lesson Information
Which lesson are you registering for? *
Select all that apply.
How many lessons would you like to schedule each week?
If you were referred by another client or coach, please include their name. Thank you!
Client Information
Parent/Guardian Name *
Parent/Guardian Name
Swimmer DOB *
Swimmer DOB
Primary Address *
Primary Address
Primary Phone *
Primary Phone
Preferred Method of Contact *
Pool Information
Do you have a pool? *
Pool Address
Pool Address
If you answered yes, please tell us where your pool is located.
Special Treat
After each lesson, we offer a special treat for a job well done. May we provide the following?
Emergency Contact
Please provide one contact name, number, and relationship to swimmer.
Agreement & Policy Information
Liability Waiver *
Liability Waiver
I, the parent/guardian of swimmer or swimmer (collectively “Client”), grant the Mobile Swim School, LLC permission to conduct and instruct swim lessons at your place of residence or the agreed upon host location with participation from Client(s) including but not limited to lesson direction, activities, and open swim. I, for myself, family, legal and personal representatives, executors, administrators, and on behalf of the Client(s), freely agree to the following terms pursuant to the medical release, hold harmless agreement, and photography release (the “Agreement”).
Billing *
Billing
Tuition is due at the beginning of each month; all lessons are prepaid. Invoices are emailed on the 30th of each month for the following month of lessons. An annual fee of $20 will also be charged with your first month of each calendar year. You may pay your invoice online with a debit/credit card or bank transfer; or you may send a check (made out to MOBILE SWIM SCHOOL, LLC) to our office. Prepaid envelopes will be provided upon request. Tuition must be paid by the 15th of each month. After the 15th, tuition is considered late and you will be subject to a $10 late fee for every week that payment is delayed.
Medical Release *
Medical Release
I hereby pre-authorize Mobile Swim School, LLC to arrange for emergency medical treatment or to provide any certified treatment including but not limited to CPR and First Aid on behalf of any Swimmer(s). I understand and assume responsibility for any costs associated with any such emergency.
Hold Harmless Agreement *
Hold Harmless Agreement
To the fullest extent permitted by Law, I will defend, indemnify and hold harmless the Mobile Swim School, LLC (the “Company”) including its current and former trustees, officers, directors, employees, volunteer workers, agents, and interns or other parties representing the Company from and against claims, damages, losses and expenses, including but not limited to attorney's fees, arising out of, or from the performance of its operations or services and for the acts or omissions of its directors, officers, employees, contractors or subcontractors, volunteers, participants, guests or other responsible parties, regardless of whether or not such claim(s), damage(s), loss(es) or expense(s) is/are caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or reduce other rights or obligations of indemnity that would otherwise exist in the absence of this agreement.
Cancellation Policy *
Cancellation Policy
Individual cancellations must be made with your coach via email or to the office at (904) 222-0703 in a timely manner. -For illness, a minimum of 12 hours must be given to receive a makeup. -All other cancellations must be made a minimum of 48 hours in advance to receive a makeup lesson. -A maximum of two makeup lessons may be scheduled each month. -Last minute cancellations will not receive a refund. Weather cancellations will be made by your coach no more than :30 minutes prior to your lesson start time. The first two weather days of each month will be held indoors. Please see your coach for details.
Photography Release *
Photo packages are now available to purchase with your swim lessons. Photos are also taken at swim school events.
*
Confirmation *
Confirmation
By signing below, you confirm that you have read and fully understand every aspect of the Registration. Your signature implies full consent to the terms and conditions listed. Thank you!