Double S Swim, LLC Private Swimming Lessons

Shannon Smith
628 Frank Black Road
Cleveland, GA 30528

Waiver of Claims for Participants

I understand that while participating in aquatic activities, such as, Swim Lessons with Double S
Swim, LLC, at 628 Frank Black Road Cleveland, GA 30528, 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 swim
lesson, solely at my own risk, with full knowledge of the danger and risks inherent therein. I
hereby release, waive, forever discharge and covenant not to sue Double S Swim, LLC,
Shannon Smith and/or her agents, servants and/or property owners, Mike Smith & Brandon
Black, 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 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 Double S Swim, LLC and my Swim Instructor, Shannon Smith.
____________________________________________ _____________________
Participant’s Signature (or Parent/Guardian if under 18) ​Date

Waiver of Claims for Guardian(s) of Participants

In regards to the participation of my family, I am aware of the possibility of minor, serious, or
fatal, accidental or other physical injury or illness occurring during or as a result of participating
in the swim lesson program with Double S Swim, LLC at 628 Frank Black Road Cleveland, GA
30528. I do hereby agree to assume all risks of such injury and will hold harmless, indemnity
and defend Double S Swim, LLC, Shannon Smith or the agents, affiliated persons and property
owners, as previously mentioned, from any and all liability, actions, causes of actions, claims
and demands for every kind or nature whatsoever which I now have or which may arise of or in
connection with any participation in activities arranged by the Swim Instructor, Shannon Smith.
The terms herein shall serve as a release and assumption of risk for my heirs, executors and
administrators for all members of my family, including any minors.
I have noted on the registration form any medical/health problems.
I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGNED IT WITH FULL
KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.
Signature: _______________________________________________ Date: ______________
Child’s Name: _______________________________________________________________
Photos may be taken throughout the week of swimming lessons. I understand that any images
of my child may be used (without names or other identifying information) for Shannon Smith’s
swimming lessons website and/or Facebook page.
___ Y​ es, you may use photos/video of my child​ ___ N​ o, you may not use photos/video of my child
Double S Swim, LLC Swimming Lesson Policies:

Enrollment: ​Classes begin promptly at their designated time to maximize every student’s time
in the water. There will be no refunds for missed classes.

Tuition: ​Tuition will be charged weekly: $100 per week for five 30-minute lessons. Students
may take additional weeks if necessary. Payment should be received by Wednesday (or by the
third lesson).

Payments:​ Cash, personal checks, and payments via the Square (debit cards) will be accepted.
Checks need to be made payable to Double S Swim, LLC.

Withdrawal: ​I ask for at least a week’s notice (if possible) of a withdrawal or cancellation of the
lesson(s).

Make-ups:​ Make-ups are scheduled if the lesson is cancelled due to weather or the instructor.
Make-ups typically occur on the Saturday (or Sunday if necessary) of the week following the
regularly scheduled lessons.

Reusable Swim Diapers​ are mandatory for all children that are not toilet trained or have
accidents.

Supervision: ​Parents/caregivers must remain at the pool during their child's 30-minute class
unless otherwise discussed and decided upon by parents/instructor.

Pool Deck Access: ​For safety, only adults and children entering the water are allowed on the
pool deck.

Property:​ Double S Swim, LLC and Shannon Smith are not responsible for any lost or stolen
property.

I have read and understand Double S Swim, LLC’s Swimming Lesson Policies:

Parent Name: __________________________________________ Date: ________________

Child’s Name: __________________________________________