Bridgewater Swim Academy - Swimming Lessons Near Me

Client's Name (Click the "+" sign to add additional children)*

First	Last	Male or Female	Birthdate (mm/dd/yyyy)

Parent's Name

First Last

Best Daytime Phone*

Home Phone

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Please indicate Dates available for lessons:

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Please indicate Times available for lessons:

7 AM – 11 AM
12PM – 3PM
4 PM – 7PM

What date are you available to start?

Please indicate dates of any prior committments that may conflict with scheduled lessons:

PRICING/REQUIREMENTS

Please call (775)440-3705 for pricing.

Requirements per child to schedule:

1) A completed and signed registration form per child must be submitted to Bridgewater Swim Academy prior to scheduling any lessons.

2) Payment in full for each registered child submitted to Bridgewater Swim Academy 3 DAYS PRIOR to the first scheduled lesson which needs to include corresponding SESSION # and each child’s name.

3) Make-ups: One make-up lesson per session of eight 30 minute lessons with 24-hour written advance notice- no exceptions, including illness. The make-up lessons may be with a different instructor.

4)Parent/guardian agrees to remain on the premise during the swim lesson. Any medical attention needed by the client will be the responsibility of the attending parent/guardian. Children and siblings will be supervised by a parent or guardian at all times when not in class. Children not participating in a swim class must be out of the pool while lessons are in progress.

Consent:

Type Name of Parent or Legal Guardian*

I have read and acknowledged the consent form above.*

Yes

POLICIES

By initialing each item below, the applicant acknowledges that you and/or the client’s guardian have read each policy and will agree to each policy. Please initial each item below.

Staff available only during Office Hours only: (Please initial box below.)*

Monday-Friday : 9:00AM- 4PM
Excludes National Holidays

Instructor requests are always welcomed, but never guaranteed. Due to unforeseen circumstances, there may be occasions when instructors will not teach on their scheduled days and we reserve the right to have other instructors fill in as necessary in order to maintain continuity in the schedule. (Please initial box below.)*

Any child that is not toilet trained is required to wear a swim diaper and an Eco Snap or Neoprene Swim Diaper underneath their swim suit.*

Lessons will only be scheduled in sessions which are 8 x 30 minute scheduled lessons. Any session may remove one week's worth of lessons (one lesson for once per week lessons) and add that one week only on to the end of the sessions. There are no exceptions. Lessons scheduled for once a week must be completed in 9 weeks. Lessons scheduled for 2 or 3 times per week must be completed in 5 weeks. (Please initial box below.)*

Bridgewater Swim Academy will require confirmation of session dates from each client. Once session dates have been confirmed, any lessons missed, will be considered a make-up (maximum of 1 make up per session). If no confirmation is received prior to the session's first lesson, no lessons will be scheduled. (Please initial box below.)*

Bridgewater Swim Academy will require both clients involved in a semi-private session to designate one person to confirm the same session schedule of lessons for all participants. (Please initial box below.)*

No refunds will be issued on or after session dates have been confirmed. Full payment amount remains due regardless of attendance. (Please initial box below.)*

A credit towards the cost of any program offered by Bridgewater Swim Academy may be issued in the event of an injury which causes a child to remain out of the water for a sustained period of time (a minimum of two full weeks). A doctor’s note may be required to validate that there is a medical reason for not swimming.

Bridgewater Swim Academy will not automatically renew additional sessions. We require clients to inform Bridgewater Swim Academy in writing, via email, one full calendar week prior to the last lesson of the current session that you would like to renew for another session. Confirmation will be required by each registrant or by designee of a semi-private lesson. (Please initial box below.)*

Payment will need to be current on any completed sessions in order to request renewal for additional SESSIONS and in order for renewal to be granted. Lack of payment being current could result in the loss of preferred time slots. (Please initial box below.)*

One make-up lesson per session of eight lessons with 24-hour written advance notice- no exceptions. The make-up lesson will be scheduled on a designated make up day and may be with a different instructor when space is available. If one partner of a semi-private lesson will need to miss their lesson and 24 hours advance notice is given to Bridgewater Swim Academy, in order for both parties to be eligible for a make up, then both parties will need to miss the lesson and the make-up for both parties will be scheduled on a designated make-up day if space is available. If one partner of a semi-private lesson misses a lesson with less than 24 hours notification to Bridgewater Swim Academy, the other partner can swim in the scheduled lesson time, but the partner unable to swim will not be eligible for a make up lesson. (Please initial box below.)*

No changes to session dates may be made following confirmation. For any changes requested following confirmation of the session dates, we will charge and invoice you a mandatory administrative fee of $40. There may be additional costs involved in the requested changes, such as differences of going from private to semi-private (or vice versa). (Please initial box below.)*

All make up lessons are required to be taken within 30 days of the date of the missed lesson. No exceptions. If a make up can't be taken on the designated make up lesson schedule, or within 30 days, then the make up will be forfeited. (Please initial box below.)*

All prices and policies are subject to change without notice. (Please initial box below.)*

Type Name of Parent or Legal Guardian*

I have read and acknowledged the "Policies" form above. Please place a checkmark next to the "YES" below.*

Yes

WAIVER/RELEASE OF LIABILITY

PLEASE READ CAREFULLY BEFORE SIGNING.
THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.

I, (Enter full name in box below.)*

the enrolled participant and/or the parent/guardian of the participant agree and understand that swimming is a hazardous activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to, paralyzing injuries and death.
The participant hereby agrees to participate in the swim lesson and hereby agrees to indemnify and hold harmless Bridgewater Swim Academy, its instructors, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in swim lesson. The participant also agrees to indemnify Bridgewater Swim Academy for any damages incurred arising from any claims, demand, action or cause of action by the participant.
The participant authorizes any representative of Bridgewater Swim Academy to have the participant treated in any medical emergency during their participation in swim lesson. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.
I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.

Type Name of Parent or Legal Guardian*

I have read and acknowledged the "Waiver/Release of Liability" form above.*

Yes

CLIENT/PARENT CONDUCT EXPECTATIONS

• Clients are not allowed to enter the pool before class, nor can a client stay in the pool after the instructor has dismissed the client. There is NO LIFEGUARD ON DUTY.
• It is the responsibility of the parent or guardian to notify the instructor of any relevant and pertinent medical circumstances, learning disabilities, or water experiences BEFORE the first class begins.
• In the unfortunate instance of a client defecating in the pool it is critical that the staff be notified immediately. After the first occurrence, the client (regardless of age) is required to wear both a disposable swim diaper along with a reusable eco snap or neoprene swim diaper. Multiple incidents will result in suspension from Bridgewater Swim Academy. A mandatory temporary pool closure (anywhere from 1 hour up to 24 hours, depending on the circumstance) will be required by the Center for Disease Control guidelines.
• Parents/guardians should encourage their children to use the restroom before class and the parent/guardian will need to be available to take the child during class in the event that this becomes necessary.
• Parents/guardians may observe the class, but it will be at the discretion of an instructor to recommend that a parent/guardian leave their child’s sight in order to limit distractions, and help to build the child’s trust with their instructor.
• Bridgewater Swim Academy strives to keep a safe, family-friendly environment. In the circumstance that management feels a person is endangering others, demonstrating inappropriate behavior, abusing the facility, or becoming aggressive toward a staff member or another customer, that person will be asked to leave the facility and their registration will be terminated.

• BSA respectfully requests that any concerns, questions, comments that need to be addressed with an instructor be made prior to or at the end of a lesson and if possible, request with the business office an opportunity to schedule some time with the instructor to address any such issues and or concerns. We will do our best to facilitate a meeting in a timely manner .

I have read and acknowledged the "Client/Parent Conduct Expectations" form above.*

Yes

Clients, events and classes are photographed or videotaped for marketing and promotional purposes in a print or web based media outlet (i.e. company website or Facebook). If you do not want your child’s image to be used, please let the photographer/videographer know during the event or class. In order to protect the privacy of the children and youth attending the event or class, parents/legal guardians are asked to select the appropriate permission level below. (Please check the one which applies)

I GRANT permission for a photo/image that includes my child to be published on the company’s public web site and/or social media sites (i.e. Facebook).
I DO NOT GRANT permission for photos/images or my child’s name to be published on ANY public online place affiliated with or operated by Bridgewater Swim Academy.

How did you hear about us?*

A Friend/Word of Mouth
Nevada Mom's
Website/Online
Social Media
Other

Please let us know if there any special needs, medical/health problems, and/or requests for your child that the staff should be aware. **Please also include any previous swim experiences, or lack thereof, relevant to your swim lesson needs.

PLEASE READ

By clicking the button below, you are confirming that you have read and acknowledged our Waiver/Release, Policies and Client/Parent Conduct Expectations forms.

Your form will not be submitted until you click the blue button below.

REGISTRATION FORM

PRICING/REQUIREMENTS

Consent:

POLICIES

WAIVER/RELEASE OF LIABILITY

CLIENT/PARENT CONDUCT EXPECTATIONS

PLEASE READ