Registration Form
Registration FormStudents Name: ... . Gender: F / M
Grade: .. Teacher: .
Date of Birth (D/M/Y): .
Address: .
.
Home Phone: .. Hand Phone: .
E-Mail: .
Parents Name: .
Past Swimming Experience: ..
Medical Condition: .
Preferred Doctor/ Hospital:
Emergency Contact No.: ...
Other Comments: .
Frequency: Once a Week Twice a Week
If Once a Week, Preferred Day: Tuesday Thursday
Accompanying Adults:
Name Relation
1
2
It is your responsibility to ensure your childs arrival at the pool on his/ her swim days. The accompanying adult is requested to stay around the poolside throughout the lessons.
(please refer to and sign the liability clause at the back of this form)
Although I understand that all care will be taken to ensure the safety of children enrolled in this swimming program, I hereby fully release and discharge JIS, its employees, officers, School Council, Board of Governor, the parent organizers, swim instructors, and all other official representatives (collectively The Released Parties) unconditionally from all liabilities whatsoever arising from my childs/ wards participation in the above mentioned program, including all incidental activities related to it. I hereby indemnify and hold the Released Parties harmless from any suit, claim or damage, including all monetary damages, medical expenses, attorneys fees, and all other claims which may arise as a result of any injury of accident occurring as a result of my childs/ wards participation.
In the event of accident or injury, I understand that every effort will be made to immediately inform me. I will be responsible to update contact information on the file with the organizers and JIS. In case I cannot be contacted, I authorize any representative of JIS or the parent organizers to act on my behalf to obtain medical care on behalf of my child/ward. I agree to pay all costs and expenses of such medical treatment and will promptly reimburse all related costs, without exception and upon demand.
Parents Signature: Date: