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STEVE WALLEN SWIM SCHOOL
1230 GLENHAVEN COURT, SUITE 100, EL DORADO HILLS, CA, 95762 |
Parent/Guardian Information
Child Information (Note: If this area is blank and your child is not listed, click the "Back" button above to "Add a child" on the previous screen)
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
Student <CHILDNUMBER> Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Age: <CHILDAGE>
This form submits a registration request. Please note, your class time is not automatically reserved in future sessions. Future sessions can be reserved in advance, with only a credit card on file, in order to secure your preferred day(s), time(s), and instructor, and as always, payment is not processed until the first class of each new session. All registrations are on a first-come, first-served basis, and classes fill quickly, so please reserve your lessons accordingly.
*No classes 4/20, 5/25 & 5/26, 8/31 & 9/1. Makeup classes can be scheduled with the front desk.
**SWSS is closed Thanksgiving Week (11/24 – 11/30) and Winter Break (12/22 – 1/4/26).
*Class Type:
*Student Ability:
Preferred Day(s): Mondays Tuesdays Wednesdays Thursdays Sundays
Preferred Time(s): Mornings Afternoons Evenings
*Student Gender: Male Female
MEDICAL HISTORY/LEARNING DIFFERENCES
*Does your child have any medical conditions, learning differences, or behavioral considerations we should be aware of to better support their swim instruction?
(For example: asthma, hearing impairment, ADHD, autism spectrum, anxiety, nonverbal, or recent injuries.)
YES NO
If yes, please explain to help us provide an instructor best suited for your student.
I, (Parent/Guardian Name), ACKNOWLEDGE that I have voluntarily permitted:
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
Student's Name: <CHILDFIRSTNAME> <CHILDLASTNAME> Born on: <CHILDBIRTHDAY>
to participate in a pool party, swim lessons, and/or activities at Steve Wallen Swim School, Inc.
I AM AWARE THAT STEVE WALLEN SWIM SCHOOL, INC. SWIM LESSONS, PARTIES, ETC., INVOLVE ACTIVE SWIMMING ACTIVITIES, AND I AM VOLUNTARILY PERMITTING MYSELF & ENROLLEE TO PARTICIPATE IN THESE ACTIVITIES WITH THE KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY, DISABILITY, DEATH, OR ILLNESS FROM ANY AND ALL INFECTIOUS DISEASE TO ENROLLEE, MYSELF OR ANYONE ELSE SIGNING BELOW, THAT MAY RESULT FROM ANY OF OUR PARTICIPATION.
In exchange for Enrollee being permitted by Steve Wallen Swim School, Inc. to participate in these activities and use its facilities, I/we hereby agree that I/we will not make a claim against or sue Steve Wallen Swim School, Inc. or any of its principals, employees, or agents, for injury or damage resulting from the use of the facility or negligence or other acts, howsoever caused, by an employee or agent of Steve Wallen Swim School, Inc. as a result of Enrollee’s or my/our participation.
In addition, I HEREBY ACKNOWLEDGE AND AGREE TO RELEASE, DEFEND, INDEMNIFY, AND HOLD HARMLESS STEVE WALLEN SWIM SCHOOL, INC., its principals, employees and agents, and to assume full responsibility for any loss or damage for any claim , lawsuit or demand for loss or damage, on account of injury to Enrollee or myself/ourselves, whether caused by the active, passive or sole negligence of Steve Wallen Swim School, Inc., its employees or agents, while Enrollee or myself/ourselves are on the property of Steve Wallen Swim School, Inc., or are participating in any way or any activity at Steve Wallen Swim School, Inc.
Should it be necessary, in the opinion of a member of the staff at Steve Wallen Swim School, Inc., to render first aid and/or assistance to Enrollee or myself/ourselves, I hereby grant permission to the staff of Steve Wallen Swim School, Inc., to render such aid and assistance if I am not present.
PHOTOS
I understand that photos and videos are occasionally taken at Steve Wallen Swim School, Inc. and that any photo or video taken of me or my child may be used for Steve Wallen Swim School, Inc. social media sites. If I change my mind at any time, I will notify Steve Wallen Swim School, Inc. in writing.
SWIM DIAPERS
Children 3 years of age or younger need to wear a Happy Nappy Duo swim diaper at swim lessons to prevent accidents and maintain hygiene standards in the water. We know your child may be fully potty trained, but this helps ensure a safe and comfortable environment for everyone involved. Happy Nappy Duo swim diapers are available at our facilities and can be purchased on your first day of class. Please see our Swim Diaper Policy for more information.
PAYMENTS
All customers are required to leave a credit card on file at the time of registration. Credit card payments will be processed on your first class of each new session. If you wish to make payment via another method, please let us know in advance. Charter students will receive a credit card refund for their classes once voucher payment is received from the charter school. For more information, please read our voucher policy.
Are you planning to get reimbursed by a third party/charter school? Yes No
If yes, please list the name of the third party/charter school:
REFUNDS
No refunds. All sales final on swim lessons, and will be given a school credit. If you cancel within 2 weeks of the start of your session there will be a $25 cancellation fee for each weekly class scheduled.
MAKE UP LESSONS
A minimum of 6 hours notice is REQUIRED to cancel a class. If 6 hours notice is not given, a $10 late cancel fee will be charged if you choose to reschedule the class. A makeup class will not be offered for missed classes when advance notice is not provided. Makeup classes expire after 6 months from the original purchase.
I have read, understand, and agree with the Consent for Emergency Medical Treatment, Informed Consent, Waiver/Release, Photos, Payments, Credit Card, Refund and Makeup policies. I also understand that an adult parent/caregiver must remain in the facility throughout my child’s swim lesson.
Web: www.wallenswim.com Phone: (916) 939-7075
Parent/Guardian Signature Below: