SWIM REGISTRATION

CHILD'S NAME: ____________________
AGE: _____ PHONE: ______________
CELL: _______________
ADDRESS: ___________________________________________________________________
EMAIL: ____________________________________________________________________

SESSION(S) #: _____CLASS LEVEL: ___________

DAYS & TIME: ______________________

PLEASE RETURN THIS FORM WITH FEES TO NORTHWEST AERIALS: 12440 128TH LANE NE,
KIRKLAND, WA 98034.

ANY QUESTIONS? CALL (425)823-2665

** PAYMENT MUST ACCOMPANY REGISTRATION, SPACES CANNOT BE HELD WITHOUT PAYMENT

**PLEASE MAKE CHECKS PAYABLE TO NORTHWEST AERIALS, VISA/MASTERCARD IS ALSO ACCEPTED

**SORRY NO REFUNDS, CREDITS OR TRANSFERS ON SWIM FEES

VISA/MC#: ____________________________________
EXP: _______________ 3 digit code: ___________

The student(s) has my approval to participate in class activities or other events organized by Northwest Aerials, Inc. I understand that like all physical activities, participation in gymnastics, dance, trampoline, swimming and fitness carries with it a reasonable degree of risk and agree that neither Northwest Aerials, Inc., nor its officers, directors, operators, agents or instructors may be held liable in any way for any occurance in connection with the student’s participation in gymnastics, dance, trampoline, fitness or swimming which may result in serious injury or other damages to me, my family, heirs or assigns. In consideration of being allowed to participate in such programs, I further personally assume all risks in connection therewith, whether foreseen or unforeseen, and further to save and hold harmless said corporation, its officers, directors, operators, agents or instructors from any claim by me, my family, estate, heirs, or assigns arising out of such participation.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND NORTHWEST AERIALS, INC., AND I HAVE SIGNED THIS OF MY OWN FREE WILL. I ALSO AGREE TO ABIDE BY ALL RULES OF ENROLLMENT.

I, as parent or guardian of _________________________give my permission for him/her to participate in gymnastics, dance, trampoline and swimming and in consideration of his/her participation, agree individually and on behalf of him/her to the terms of the above agreement and release of liability.

Northwest Aerials, Inc. has my permission to secure emergency medical attention if I cannot be reached immediately. I ALSO UNDERSTAND THAT THERE ARE NO CREDITS, TRANSFERS OR REFUNDS ON SWIM FEES AND I UNDERSTAND THE MAKE UP POLICY FOR SWIM LESSONS.

Parent/Guardian Signature: ______________________________
Date: ____________