Registration - Red Maple

Name

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Last

Date of Birth

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Parent/Guardian Name (if applicable)

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Last

Parent/Guardian Phone Number (if applicable)

Parent/Guardian Email Address (if applicable)

Emergency Contact Name

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Last

Relationship to Participant

Emergency Contact Phone Number

Program of Interest:

Medical Information

Please list any relevant medical conditions, allergies, or special needs that should be noted. If none, please write "N/A."

Session Details

Participant's Singniture

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How did you hear about us?

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By submitting this form, I, the undersigned, understand and acknowledge that participation in swimming lessons involves inherent risks. I consent to and agree with the conditions stated herein, and I release RED MAPLE SWIM & WATER POLO CLUB and its instructors from any liability in case of accidents and injuries that may occur during the lessons.