1. finance
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PRIVATE LESSONS:
Swim School Registration 2015
$30 for ½ hour lesson, each added person is $15
If paying for a block of 5 lessons; receive a 20% discount! (As priced below)
Parent/Guardian: ____________________________________________________ Phone: ________________________________________
Address: _________________________________________________ City: _____________________________ Zip: ___________________
Alternate Phone(s): _____________________________________________ Email: _____________________________________________
Emergency Contact Name: ______________________________________________ Phone: ___________________________________
The above address is:
Resident of :
Summer Address
Charlevoix Township
Year-Round Address
Hayes Township
City of Charlevoix
Non-Resident
Or:
Participant Names/Birthdays: _______________________________________________________________________________________
□ Beginner
Swimming Ability:
□ Intermediate
□ Advanced
Days/Times preferred:
□ Monday
□ Tuesday
□ Morning
□ Wednesday
□ Thursday
□ Afternoon
□ Friday
□ Evening
□ Saturday
Private Lesson
□ 1-4 Lessons
30 Minute Lesson(s)
□ 5 Lessons
Fee: $30/Lesson
30 Minute Lessons
Fee: $120
Semi-Private Lesson
□ 1-4 Lessons
□ 5 Lessons
□ 1-4 Lessons
□ 5 Lessons
Two Participants
Two Participants
Three Participants
Three Participants
30 Minute Lesson(s)
30 Minute Lessons
30 Minute Lesson(s)
30 Minute Lessons
Fee: $45/Lesson
Fee: $180
Fee: $60/Lesson
Fee: $240
Payment:
Total amount enclosed: __________________
Visa
or
Cash
Credit Card
Check # ___________________ (Payable to CACP)
MasterCard CC#: _______________________________________________ Exp Date: ________________
Zipcode: ____________________
In signing this form, I understand that:
No-shows or cancellations received less than 24 hours before a scheduled appointment will be charged to the client.
No refunds are given for missed/unused private lessons.
Lessons must be scheduled within 3 months from purchase date and used within 6 months of the purchase date.
The participant is expected to be punctual and understand that the instructor may have appointments immediately preceding or
following their appointment. The instructor is not obligated to stay past the allotted time scheduled or the appointment.
No more than 3 participants are allowed per semi-private lesson.
I HAVE READ AND AGREED TO ALL REQUIREMENTS ON BOTH PAGES OF THIS FORM
Adult Signature: ___________________________________________________________________________ Date: __________________________________________
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PRIVATE LESSONS:
Swim School Registration 2015
Participation in any activity at the Charlevoix Area Community Pool is at the sole discretion and judgment of the patron, and at his or
her own risk. I, the signatory, for myself and 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 and do hereby fully and forever release and discharge Charlevoix
Area Community Pool, its agents, or employees, and the Charlevoix Friends of the Pool Board from any and all suits, claims, damages,
costs and expenses of every kind, in conjunction with the use of this facility and equipment thereof, except that arising out of sole
negligence of the Charlevoix Area Community Pool. I, the signatory, for myself and my dependents, further agree to use all equipment
and the facility properly and leave them in good condition. I, the signatory, assume total liability and agree to reimburse the
Charlevoix Area Community Pool for all damages incurred through the misuse of the facility and/or equipment thereof. I, the
signatory, certify that the information given in this application is complete and accurate.
Private and Semi Private Swim Lessons:
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Lessons are 30 Minutes in Length and take place at the Charlevoix Area Community Pool.
Times of lessons will be based upon availability of the pool and the instructor, not all times are
available.
No-shows or cancellations received less than 24 hours before a scheduled appointment will be charged to
the client.
No refunds are given for missed/unused private lessons.
Lessons must be scheduled within 3 months from purchase date and used within 6 months of the
purchase date.
The participant is expected to be punctual and understand that the instructor may have appointments
immediately preceding or following their appointment. The instructor is not obligated to stay past the
allotted time scheduled or the appointment.
No more than 3 participants are allowed per semi-private lesson.
Once this registration is completed and submitted, your registration will be given to a private lesson
instructor who will work directly with you to determine the days and times of the lessons.
Lessons need to be paid for at the beginning of the first lesson or earlier.
Private Lesson(s) Scheduled:
□ 1-4 Lessons:
□ 5 Lessons:
Semi-Private Lesson(s) Scheduled:
□ 1-4 Lessons with Two Participants:
□ 5 Lessons with Two Participants:
□ 1-4 Lessons with Three Participants:
□ 5 Lessons with Three Participants:
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