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H2OPE Registration Form

A signed Doctor's Release is required before your child may participate. CLICK HERE to download the form. You may mail it to us or bring it with you to the first class.

PLEASE NOTE:
The Doctor's release is valid for 12 months, unless there is a change in medical status which requires a new release. If the participant drops from the program for a period longer than 30 days/1 month, they will need a new release and to re-register.

You may fill out this Registration Form below on line

or print one off the registration form for Harris HEB Eulto fill out and mail, or bring to us.

MAKE SURE YOU "ELECTRONICALLY" SIGN AND DATE THIS ONLINE FORM AT THE BOTTOM

MINOR CHILD INFORMATION

PARENT/GUARDIAN INFORMATION

A value is required.

A value is required.

, TX

EMERGENCY CONTACT INFORMATION

All classes are on Saturdays

PARENT'S OR GUARDIAN'S LIABILITY RELEASE AND INDEMNIFICATION

The undersigned desires to utilize the facilities provided by Off The Deep End Aquatics, Inc., Texas Health: Harris HEB Physical Medicine and Rehabilitation Center , Euless, TX, and Presbyterian Hospital CVC Center, Dallas, TX, in their water exercise H2OPE program for the purpose of swim instruction and recreation.  As a consideration for the right and privilege of being permitted access to the water exercise H2OPE program and use of its facilities, the undersigned does hereby release Off The Deep End Aquatics Inc., Texas Health: Harris HEB Physical Medicine and Rehabilitation Center, and Presbyterian Hospital CVC Center, and each and every one of the employees and instructors working or supervising activities in the water exercise H2OPE program from any and all liability, of any kind whatsoever, arising out of any physical or mental injury, or death, incurred or suffered by the undersigned or the above-mentioned minor while preparing to use, using or cleaning up after using any of the aquatic, swimming or any other facilities provided by Off The Deep End Aquatics Inc., Texas Health: Harris HEB Physical Medicine and Rehabilitation Center, and Presbyterian Hospital CVC Center, in their water exercise H2OPE program.

In executing the foregoing release, the undersigned acknowledges and affirms that he or she has carefully read the same and has asked and obtained satisfactory explanation of any part thereof that he or she does not understand. Furthermore, the undersigned acknowledges that he or she is fully aware that there may be a health risk for certain individuals participating in activities involving physical exertion or exposure to heat. The undersigned affirmatively acknowledges that he or she has made the Swim Instructor aware of any limitations suggested by his or her physicians.

In consideration of the Minor listed above being permitted by Off The Deep End Aquatics Inc., Texas Health: Harris HEB Physical Medicine and Rehabilitation Center, and Presbyterian Hospital CVC Center, to participate in their activity and to use their or anyone else's equipment and/or facilities for this activity, I further agree to indemnify and hold harmless Off The Deep End Aquatics Inc. and Texas Health: Harris HEB Physical Medicine and Rehabilitation Center, and Presbyterian Hospital CVC Center, from any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by the Minor Child above.

Please make a selection.

By typing in your full name and date in the box provided below you agree to the above Liability Release and Indemnification, and agree that this is you typing in the information.  

A value is required.

 

For more information on any Water Aerobics, Aquatic Exercise or

Swimming Class, call Off The Deep End Aquatics at

(682) 200-7865

 

 

 

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