Skip to content
Water Safety
Home
Water Safety
Swimming Pool Safety Services in USA
Water Safety Facts
Beach & Pool Safety Tips
Swim Test Protocol
Water Safety Awareness Program in USA
Services
Management
Lifeguard Services in USA
Pool Management
Sport Facility Management in USA
Resort Management Services
Waterpark Management
Beach Management
Commercial Pool Construction
Benefits
Services
National Aquatic Services
Aquatic Advertising
Sponsorships
Consulting
Inspections
Aquatic Witness Program
USA Trust Accounts
Aquatic Jobs
Aquatic Jobs
Aquatic Positions
Lifeguard Jobs & Staffing in USA
International Program
Certified Pool Operator Course in USA
Certified Pool Operator Jobs
Programs & Events
Programs & Events
Pool Activities
Fun Pak – Swimming Pool Games
KIDS SAFE
Aquatic Rentals
Swim Lesson Sign Up
Aquatic News
Aquatic News
Raising Young Adults
Lifeguard Companies
Pool Operators
Pool Company
Market Your Aquatic Facility
Community Networking
Administrative
Proposal
Customer Login
Request a Proposal
Contact Us
About Us
Forms
Facility Inspection Checklist
Chemical Order Form
Lifeguard Certification Course Form
Going Under (manual pay request)
Vendor Registration
Returns & Refunds
Menu
Water Safety
Home
Water Safety
Swimming Pool Safety Services in USA
Water Safety Facts
Beach & Pool Safety Tips
Swim Test Protocol
Water Safety Awareness Program in USA
Services
Management
Lifeguard Services in USA
Pool Management
Sport Facility Management in USA
Resort Management Services
Waterpark Management
Beach Management
Commercial Pool Construction
Benefits
Services
National Aquatic Services
Aquatic Advertising
Sponsorships
Consulting
Inspections
Aquatic Witness Program
USA Trust Accounts
Aquatic Jobs
Aquatic Jobs
Aquatic Positions
Lifeguard Jobs & Staffing in USA
International Program
Certified Pool Operator Course in USA
Certified Pool Operator Jobs
Programs & Events
Programs & Events
Pool Activities
Fun Pak – Swimming Pool Games
KIDS SAFE
Aquatic Rentals
Swim Lesson Sign Up
Aquatic News
Aquatic News
Raising Young Adults
Lifeguard Companies
Pool Operators
Pool Company
Market Your Aquatic Facility
Community Networking
Administrative
Proposal
Customer Login
Request a Proposal
Contact Us
About Us
Forms
Facility Inspection Checklist
Chemical Order Form
Lifeguard Certification Course Form
Going Under (manual pay request)
Vendor Registration
Returns & Refunds
NOW HIRING
USE CODE “US04”
Swim Lesson Sign Up
Swim Lesson Sign Up Form
Please enable JavaScript in your browser to complete this form.
Name of Facility
*
Name of Participant
*
First
Last
Guardian Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Today’s Date
*
Date Of Birth
*
Phone Number
*
Email
*
Lesson of Interest
*
Group Lesson
Semi Private
Private
Preferred start date
Preferred start time
-
This sign up sheet will be processed with the corporate office at which point a representative will reach out to you with pricing and payment details. All Payments must be received before the start of swim lessons. If you have any questions or problems prior to or during the lessons, please call the office at 877-248-1872.
Lesson Birth Phone
Waiver and Release of Liability *
*
I AGREE
Please read and complete In the event of a medical emergency, the undersigned Parent/Guardian of the above named participant, hereby grants authorization to USA Pools (USA) and its representatives, to employ any legally licensed physician or healthcare facility and to direct and/or order emergency medical treatment for the above named participant. I, the undersigned, further agrees that neither USA, nor any of its representatives shall be liable under any circumstances to anyone for exercising the foregoing authority in the event of an emergency. I, the undersigned, as the parent or legal guardian of the child listed on this application in consideration of the request and permission to participate in USA programs, including, but not limited to Swim Lessons, Swim Teams, and any other events hereby assume full responsibility for all risks of injury or loss which may result from my son/daughter’s participation in this activity and hereby agree to hold harmless, release and forever discharge USA, its officers, agents and employees from and waive any and all claims and demands whatsoever which the persons, or damage to or loss or destruction of any property arising or resulting directly or indirectly from my son/daughter’s participation in the aforementioned program and occurring during said participation or any time subsequent thereto, save and except that the above provisions shall not be applicable injury to or death of persons, or damage to or loss of property of which is the result of gross negligence or terms of this release shall serve as a release and assumption of risk for my son/daughter, heirs, executors and administrators and for all my family members. I further understand that it is my responsibility as their parent or guardian to watch and keep safe my son/daughter’s in and around water at all times. I understand, agree, and acknowledge that there are risks inherent in sporting activities conducted by USA including, but not limited to paralyzing injuries, brain injuries, and death. These activities may be of a hazardous nature and include strenuous exercise and vigorous physical activities. With the full understanding of the facts, I state, that to the best of my knowledge, my son/daughter listed on this application has no medical, physical, mental or emotional health condition which would hinder or prevent his/her active participation in USA’s programs. I also understand that photos are occasionally taken during scheduled activities and that any photo taken of my child may be used for USA publicity purposes. I have read and understood, and I agree with the informed consent and release and the emergency medical authorization outlined above as it relates to my son/daughter.
Submit