Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

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Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Waiver *

It is my (parent or guardian) expressed intention to hold Tankproof, Imagine Swimming, or any associated party harmless for any and all injuries, death, or damages arising from or in any way related to swimming lessons at Imagine Swimming.

I agree to the terms in this waiver

Photo Release *

I hereby grant Tankproof or any related entities to use for promotional purposes, photographs and video taken of my child or myself during swimming lessons.

I agree to the terms