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Swim Lesson Registration

  1. Swimmer Information
  2. Emergency Contacts (please indicate 2)
  3. Swim Lesson Information
  4. Has swimmer participated in swim lessons before?*
  5. Waiver of Liability
    I am/my child is voluntarily participating in WePLAY Swim Lessons organized by the Recreation & Parks Department of the City of Winston-Salem (hereinafter, the “City”). In consideration of the City’s organization of the WePLAY Swim Lessons, I agree to hold the City, its employees, agents, agents, and volunteers, harmless from and against any and all claims, liabilities, demands, damages, actions or causes of action, of any kind or character (including, without limitation, attorney’s fees, costs and expenses) that may arise in any manner by reason of injury or damage to myself/my child’s person (including illness or death), property or both as a result of his/her participation Swim Lesson. I understand that during myself/my child’s participation in WePLAY Swim Lessons (s)he is subject to the rules and regulations of the Recreation & Parks Department. I further understand and agree that this Waiver of Liability is binding upon my executors, administrators, personal representatives, collectors, heirs, successors, and assigns.
  6. Please Print and Sign, bring to preferred pool for registration
  7. Leave This Blank: