Please complete all sections. Payment MUST be received by September 12 or slot will be automatically deleted. Drop off times include August 25th

from 8:00am-9:30AM and 5:30-6:30PM. Also August 26 th-28 th 8am-9:30am in labeled envelope with all information. Drop off will be at Connetquot HS pool. Discount of 10% for swim team siblings ONLY.

Group lessons: $250

Pre-Team $350

Private Lessons: $375

DATES:

September 19, 26,

October 3, 17, 24, 31, November 7, 14, 21,

December 5.

View Groups Here: https://canva.link/11fxtganvhoas7m

30 minutes

Connetquot Swim Club

Submission Deadline: September 9, 2026 at 3:18 PM (Eastern Time)

Guardian/ Parent Name *

Phone *

I consent to receive text messages from the form organizer.

Email *

Swimmer's Name *

Swimmer's Age *

Does the swimmer have any medical conditions or allergies we should be aware of?

MINIMUM AGE for GROUP CLASSES IS 4 YEARS FOR FIRST CLASS. MUST BE ABLE TO SEPARATE FROM GROWNUP COMFORTABLY (no tears) and MUST wear swim diaper if not trained. *Level 1 students may use back flotations at teacher discretion to build confidence and ensure safety. PAYMENT: CASH OR CHECK dropped off to Connetquot High School Pool on August 25th between . Checks made out to Connetquot Swim Club **INCLUDE CHILD'S NAME, AMOUNT, AND CLASS REQUESTED. *

I understand and agree.

For the safety of all participants, no parent or guardian is allowed on the pool deck at any time during the program. Must remain BEHIND metal rail. *

I understand and agree.

We occasionally take pictures of the kids in action swimming or doing other activities. We hope to use these to keep parents and the community up to date on the happenings at the Connetquot Swim Club. *

Opt us out.

Fine with occasional photo/video.

Waiver *

Waiver of Liability & Hold Harmless Agreement" Waiver of Claims for Participants I understand that while participating in Connetquot Swim Club Activities, such as Swim Lessons at the Connetquot HS pool, there are inherent risks of physical and mental conditions, illnesses and/or injuries associated with engaging in physical activity and use of equipment being led by my Swim Instructor. I hereby consent to engage in the lesson, solely at my own risk, with full knowledge of the danger and risks inherent there in. I hereby release, waive, forever discharge and covenant not to sue CSC and/or their agents, servants and/or employees for any and all injuries, losses or damages and/or any claims or demands of any type, known or unknown, on account of or in any way related to any illness, condition, and/or injury to my person or property, or which may result in my or child's death. I further acknowledge the need for certain rules and regulations regarding use of the pool, equipment, facilities and other procedures related to aquatic activities. I therefore agree to abide by any and all such rules adopted by Connetquot Swim Club. Confirmation *I confirm that I have read and understood the agreement above titled "Waiver of Liability & Hold Harmless Agreement" I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT and that my signature below applies to this agreement. I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Untitled Question *

Due to course content, class schedules, and participation numbers, you may only attend the class in which you are enrolled. No make-ups are allowed in other classes. Requests for pro-rating fees must be authorized prior to the first scheduled class and are at the discretion of CSC Management. These are scheduled class sessions, if your child misses any classes during the session, you will not be refunded for the missed class. Regardless of your arrival time, classes will start and end at the scheduled time. Canceled class by CSC will be made up at alternative dates TBD, usually the week after our last class.

Payment Options

Pay with Venmo (3267)

Connetquot Swim Club Fall Swim Lesson Sign-Up

We picked this option for you:

Does the swimmer have any medical conditions or allergies we should be aware of?

For the safety of all participants, no parent or guardian is allowed on the pool deck at any time during the program. Must remain BEHIND metal rail. *

We occasionally take pictures of the kids in action swimming or doing other activities. We hope to use these to keep parents and the community up to date on the happenings at the Connetquot Swim Club. *

Waiver *

Untitled Question *

Payment Options

Connetquot Swim Club Fall Swim Lesson Sign-Up

We picked this option for you:

Does the swimmer have any medical conditions or allergies we should be aware of?

For the safety of all participants, no parent or guardian is allowed on the pool deck at any time during the program. Must remain BEHIND metal rail. *

We occasionally take pictures of the kids in action swimming or doing other activities. We hope to use these to keep parents and the community up to date on the happenings at the Connetquot Swim Club. *

Waiver *

Untitled Question *

Payment Options

Will drop off check or cash prior to September 12

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