Please complete registration form thoroughly. No student shall be

Please complete registration form thoroughly. No student shall be registered unless
registration form is complete and payment is received.
Date:_______________
(M/D/Y)
Adult/Parent/Guardian__________________________________________________________
Phone/Home________________________________Work______________________________
Email Address____________________________________
Address___________________________________________City____________Postal_______
Alternate/Emergency/Contact_______________________Relationship__________________
Phone_______________________________
Please List any Special Needs/ Medical/Health issues/ (ie. Seizures, Asthma, Allergies, etc.):
______________________________________________________________________________
Payment:
Cheque (payable to Erin Marton)
Cash
Session:
Fall
Summer
Students
Full name
Student 1
Student 2
Winter
Spring
(Check all sessions that apply)
Class/
Lesson name
Parent and Tot
Preschool(1-5)
1 2 3 4 5
Swimmer (1 to 6)
1 2 3 4 5 6
Advanced (Patrol (Rookie,
Ranger, Star, etc .)
Adult(1.Beg./2.Inter/3.Adv.)
1 2 3
Parent and Tot
Preschool(1-5)
1 2 3 4 5
Swimmer (1 to 6)
1 2 3 4 5 6
Advanced (Patrol( Rookie,
Ranger, Star, etc.)
Adult(1.Beg./2.Inter/3.Adv.)
1 2 3
Date of
Birth
M/D/Y
Time and Day
1st Choice
/
1/2
Hr
2ndchoice
Choice 2:
Day_______________
(M/D/Y)
(M/D/Y)
Amount: $__________
Full
hr
**To select a time and day look to the schedule on 400swim.com.
The more flexible you are with time and day the more 400 Swim
will be able to accommodate you.
Choice 1:
Day______________
Credits/Coupons
Code:___________
1
Credit Card (Visa, Master Card, American Express)
Time______________
Time______________
Notes:_____________
__________________
__________________
__________________
Notes:_______________
____________________
____________________
_____________________
Choice 1:
Day______________
Choice 2:
Day_______________
Time______________
Time______________
Notes:_____________
__________________
__________________
__________________
Notes:_______________
____________________
____________________
_____________________
Group
Group
Private
Private
SemiPrivate
SemiPrivate
Group
Group
Private
Private
SemiPrivate
SemiPrivate
In the Fee Column add all the
costs for each session together
and place the total here.
All taxes have been included in
price.
Fee
(Prices and Fees
can be found on
the registration
page of
400swim.com)
(Season/Year)
Fall____
1. $_____
Winter____
2. $_____
Spring____
3. $_____
Summer___
4. $_____
(Season/Year)
Fall____
1.$______
Winter____
2.$______
Spring____
3.$______
Summer___
4.$______
Total
Release
Release(s) 400 Swim’s, its affiliates, associates, directors, officers, agents and employees from
all claims and liabilities whatsoever developing from participation in or attendance 400 Swim’s
current or future programs by the undersigned, the undersigned's child(ren) or any associated
spectator(s);
Missed Lesson Policy
NO MAKE-UP LESSON OR OTHER FINANCIAL CREDIT/REFUND WILL BE AVAILABLE in connection
with a missed lesson other than if 400 Swim initiates the closing if unexpected occurrences
arise e.g. pool fouling.
Refunds/Credits
Acknowledge(s) a credit towards a session of lessons for 400 Swim programs in the next twelve
(12) months (following withdrawal) will be available should a student withdraw before the date
of the third lesson of the current session. On or after the date of the third lesson of the current
session, a credit towards lessons in the next (12) months (but no monetary refund) will be
available should a student withdraw.
Cancellation may occur by 400 Swim due to insufficient registration or any other reason, a full
refund (without any deduction) will be issued unless another mutually acceptable alternative
can be found.
Class Changes
During the session. Change requests must be given by written request. There is no guarantee
that a requested change can be made.
400 Swim Policies
Acknowledge(s) that he/she has read, understands and accepts all of 400 Swim’s information
as outlined:
The rule/health regulation that no food, drink or street shoes are allowed on the pool deck
NSF Cheques/Declined Credit Card
Acknowledge(s) that a cheque returned due to non-sufficient funds must be replaced
immediately with cash or certified cheque covering the full amount owing, together with an
additional administrative charge of $35.00.
2
Program Cancellation
Acknowledge(s) that while 400 Swim tries to balance providing sufficient notice of cancellation
and not cancelling a program. Prematurely, 400 Swim reserves the right to cancel any program,
in which case a full refund will be issued for any payment previously made.
Termination of participant
Acknowledge(s) that the Directors of 400 Swim reserve the right to terminate the registration
of any participant(s) if, in their sole discretion, the Directors determine such termination to be
in the best interest of the participant or program;
I_______________________________ assume full responsibility for payment and acknowledge
(Print name of Parent/Guardian)
that I’ve read and understood all 400 Swim policies and 400 Swim can rely on all
representations made and information given.
Participant’s Signature: ________________________________
(Parent or Legal Guardian, 18 years & older)
3
Date:_____________________