Our Waiver - Noonan Family Swim School, Inc. | Noonan Family Swim School, Inc.

Location *

Del Mar
Carlsbad
Linda Vista
Murrieta
Rancho Bernardo / 4S Ranch

CHILD NAME *

First

Last

DOB *

AGE *

SEX

please select an option

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SECOND CHILD

First

Last

DOB

AGE

SEX

please select an option

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THIRD CHILD

First

Last

DOB

AGE

SEX

please select an option

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PARENT NAME #1 *

First

Last

PARENT NAME #2

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

PHONE NUMBER HOME *

PHONE NUMBER CELL *

Email *

HOW DID YOU HEAR ABOUT US?

WEB, FRIEND, AD OR OTHER?

FIRST EMERGENCY CONTACT *

First

Last

RELATION *

PHONE *

MEDICAL HISTORY

PREFERRED HOSPITAL *

FAMILY DOCTOR *

PHONE *

INFORMED CONSENT AND WAIVER/RELEASE

POLICIES & PROCEDURES *

I UNDERSTAND

I HAVE READ, UNDERSTAND AND RECEIVED A COPY OF NOONAN FAMILY SWIM SCHOOL, INC. POLICIES & PROCEDURES

PHOTOS *

I UNDERSTAND

I ALSO UNDERSTAND PHOTOS ARE OCCASIONALLY TAKEN AT NOONAN FACILITIES AND THAT ANY PHOTO TAKEN OF MY CHILD (CHILDREN) MAY BE USED FOR NOONAN PUBLICITY PURPOSES.

I HAVE READ AND UNDERSTAND, AND I AGREE WITH THE INFORMED CONSENT AND RELEASE AND THE EMERGENCY MEDICAL AUTHORIZATION OUTLINED ABOVE AS IT RELATES TO MY SON(S) DAUGHTER(S) *

PARENT OR GUARDIAN (TYPE FULL NAME)

DATE *

Name *

First

Last

Waiver

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