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Swim Lesson Program Registration
Off The Deep End Aquatics, Inc. and VIRIDIAN
We require payment in advance to hold your class. All participants are required to sign a liability release form before lessons begin.
To register by phone, call 682-200-7865.
To register by mail, Click Here to print the Registration, Liability Release and Indemnification form (pdf file). Fill out form and enclose it with a check made payable to Off The Deep End Aquatics.
Once registered, we will contact you to schedule your dates, time, and then a follow up email confirming them with a link to PayPal to pay with your credit card.
To register ONLINE fill out the form below:
One Session =4 days/wk for 2 weeks, Monday through Thursday
Student Information
First Name: Last Name:
(If student under 18, please add Parent/Guardian name) First Last Name:
Student's Date of Birth (mm/dd/yyyy): Gender: Male Female
Water comfort level (OK, Cautious, Afraid?): Previous swim lessons? Yes No
If Yes, where?:
Skill Level: Little & Me babies Group Level I - New to Swimming Level II - Basic Swimming Skills Level III - Swims Freestyle & Backstroke Level IV - Advanced Swimming
Session Selection: PLEASE NOTE - THE TIMES YOU REQUEST DEPENDS ON IF THE CLASS IS FULL OR NOT.
ALSO:.............YOU MAY ONLY SELECT MORNING TIMES FOR MORNING DATES LISTED
Preferred Date: Morning June 5-15 Evening June 6-22 Morning June 19-29 Morning July 10-20 Evening July 11-27 Preferred Time:(we will call you to set specific time) Morning 9-9:30am Morning 9:40-10:10am Morning 10:20-10:50am Evening 6:15-6:55pm Evening 7-7:40pm Evening 7:50-8:30pm
Session Type: Group Session $100.00 Semi-Private (2 people) $175 each Private 0ne on One $350
Email: A value is required.
Home Phone: A value is required. Mobile or Work Phone:
Street Address:
City: , TX Zip Code:
Emergency Contact Information
Full Name Phone Number:
Preferred Doctor: Phone Number:
How did you hear about us? Facebook Brochure/Flyer Internet Search Local Ad Referred by a Friend Repeat Customer
PARENT'S OR GUARDIAN'S LIABILITY RELEASE AND INDEMNIFICATION
The undersigned desires to utilize the facilities provided by Off The Deep End Aquatics, Inc., and Viridian of Arlington, Texas in its learn-to-swim fitness program in Arlington, Texas, for the purpose of swim instruction and recreation. As a consideration for the right and privilege of being permitted access to the swim program and use of its facilities, the undersigned does hereby release Off The Deep End Aquatics, Inc., and Viridian of Arlington, Texas and each and every one of the employees and instructors working or supervising activities in the learn-to-swim 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. and Viridian of Arlington, Texas in its learn-to-swim 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 student named above being permitted by Off The Deep End Aquatics, Inc. and Viridian of Arlington, Texas to participate in this 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 Viridian of Arlington, Texas from any and all Claims which are brought by, or on behalf of the student, and which are in any way connected with such use or participation by the student.
Check box to agree to Liability Release and Indemnification 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.
Full Name and Date 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
