Saturday Swim School Registration
Month: ___________________________
Participation in any activity at the Charlevoix Area Community Pool is at the sole discretion & judgment of the patron, & at his or her own risk. I, the undersigned, for myself & my
dependents, assume full responsibility for any injuries or damages which may occur to me or my dependents, in, on or about the premises of the facility & do hereby fully & forever release &
discharge Charlevoix Area Community Pool, its agents, or employees, & he Charlevoix Friends of the Pool Board from any & all suits, claims, damages, costs & expenses of every kind, in
conjunction with the use of this facility & equipment thereof, except that arising out of sole negligence of the Charlevoix Area Community Pool. I, the undersigned, for myself & my
dependents, further agree to use all equipment & the facility properly & leave them in good condition. You assume totally liability & agree to reimburse the Charlevoix Area Community Pool
for all damages incurred through the misuse of the facility &/or equipment thereof. I, the undersigned, certify that the information given in this application is complete & accurate.
Today’s Date: _______/_________/________
Parent/Guardian: ____________________________________________Preferred Phone:_________________________________
Address: _________________________________________________ City: ____________________________ Zip: ___________________
Email: ______________________________________________________________
Emergency Contact: _____________________________________________ Phone: ___________________________________
The above address is:
District Resident of:
Charlevoix Township
Summer Address
Hayes Township
Year-Round Address
City of Charlevoix
Or:
Non-District Resident
*Please Check-In at the beginning of each lesson.
CLASSES ARE LIMITED TO THE FIRST 7 PARTICIPANTS THAT HAVE PAID FOR THEIR LESSONS
The minimum number to hold the class is 2 students in each class.
*REFUND POLICY - Cancellations made 7 days prior to the FIRST day of swim lessons will receive a full refund.
A $5 handling charge will be deducted for late cancellations. No refunds will be granted after classes have begun.
*MAKE-UPS - Make-ups are not allowed unless the class is cancelled by the CACP.
Please Indicate Session and Circle Class/Time:
*Class Times May Vary by Month – See Swim Lesson Schedule for Correct Times
Child’s Name: _______________________ Child’s Name: _______________________ Child’s Name: _______________________
Child’s Age: _____________
Child’s Age: _____________
Child’s Age: _____________
Swim Lesson Class:
Time:
Swim Lesson Class:
Swim Lesson Class:
Infant/Toddler
Infant/Toddler
Infant/Toddler
Preschool
Preschool
Preschool
Level 1
Level 1
Level 1
Level 2
Level 2
Level 2
Level 3
Level 3
Level 3
Level 4
Level 4
Level 4
Level 5
Level 5
Level 5
TOTAL COST: ____________
PAYMENT
Time:
Cash
Check # ___________________
Visa or MasterCard:
CC#: ______________________________________________
Exp Date: ______________ Zipcode: ________________
Name on Card (if Other): _______________________________
Time:
Office Use Only:
Date Info Received:_________________
By:_________________________
Did they pay? YES / NO
If so, How?_____________________
Processed in POS? YES / NO