2024 New Student and Waitlist Registration

Welcome, and thank you for making water safety a priority for your child(ren)!

Please complete the following registration form (one per child). The more flexible you are with your time availability and location, the sooner you will be added to the schedule. Because our swim schedule is performance-based your child will receive a target month/date to start. If it is not possible to place you at your requested time/location, you will be offered an alternative. If you choose not to accept the alternate, your child will be placed in the queue and you will be notified as soon as an opening becomes available. Sometimes there are cancellations and early completions which will move everyone sooner in the queue.

If your child has swam with another "survival" swim program there are a few 3-4 week refresher sessions available .

If you have additional questions, concerns, or would like to discuss lessons in further detail, please call or email. 407-252-7159 tina@littleotterswimacademy.com

The following form will take approximately 10 minutes to complete. If there is a chance you might get interrupted along the way, please consider the "save and return" option. It will time out if left open. There are many required fields. Please don't leave any of these fields blank, as the submission will be returned. At the end of the form, you will be redirected to Paypal for payment (if applicable). Your registration will be complete when your payment is processed. If you have trouble getting to Paypal please call or email me and I will send the link manually. Some operating systems will glitch here. You will receive a confirmation email with further instructions on what's next!

Thank you for trusting me to teach your child(ren) to swim and be safer in and around the water.

Save & Return

Save and Return. Use an account to return to saved work.

Participant Information

Student First Name *

Last Name *

Gender *

Birth Date * +

Parent/Guardian Contact Information

Relationship to Participant: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Cell Phone number *

text? *

yes

Primary Email Address *

Street Address *

Address Line 2

City *

Zip Code *

Occupation

Secondary Contact Information: If someone other than the person above will be attending lessons with the child, please provide their information here.

Relationship to Participant:

Mother

Father

Guardian

Other Other

First Name

Last Name

Cell Phone number

text?

yes

Email Address

Health Information

Pediatrician name *

Pediatrician Phone # *

1.Has this child ever been referred to or seen a specialist of any kind? If YES is selected, please give details below. *

yes

2.If YES was answered to the above question, please list ALL physicians, therapists, specialists/personnel and the purpose for the visit, including all physical exceptionalities. **Please exclude well check ups.

3. If under the age of 2: At what age did this child begin to walk? What distance can he/she walk unassisted? *

4. If younger than 12 months when did this child begin to crawl?

5. If this child is under the age of 12 months at what age was he/she sitting up unassisted?

Aquatic Information

1. Has this child participated in previous swimming lessons? If yes, please indicate where lessons took place, previous instructor/program. If no formal training please indicate the child's reaction to water poured over the head/body. *

2. What is the intended aquatic goal for this child? *

3. Has this child ever been placed in a floating raft/tube, or used water wings, sometimes referred to as armbands, puddle jumper, or floaties? *

Seated Floating Raft/Tube

Water Wings / Puddle Jumper

None

Scheduling Information

1. Where would you like lessons to take place? The more flexible you are with the location the sooner I will be able to accommodate you. You may check multiple boxes! * 🛈

My home pool (pool must be heated to above 83)

Instructor Provided Host Pool

I would like my pool be considered for Hosting. (Please complete a Host Request Form - separate from this one found on the Little Otters Swim Academy web site)

Other Other

2. If you indicated above that you would like lessons to take place at your home pool please indicate how your pool is heated

Solar Panels

Heat Pump

Gas

Other Other

3. Preferred Lesson time (check as many boxes as possible):
The time MUST be the same every day, Monday-Thursday.
**Please keep in mind the more flexible you are with times the faster you will get on the schedule! * 🛈

7am to 9am (June to September only)*travel students only

9am-Noon (June to August) * host pools only

1pm-4pm (April - May) *host pools and travel students

If you have a specific time need/preference (i.e. lunch break) within the above listed windows of time please list it here: If you have a specific time need/preference (i.e. lunch break) within the above listed windows of time please list it here:

4. Are there any date restrictions to note (i.e. school, camp, vacations/trips, dr appts, etc) over the course of the spring/summer, when you/child are unable to attend lessons? Please list all here for reference.

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5. What is your PREFERED start month? Please keep in mind that late afternoon lessons are only offered through the end of May. The last round of students will be accepted in August and run through the first week of October. Late October and November are reserved for refresher lessons (previously skilled students).

July

August

6. How did you find Tina Baron/ Little Otters Swim Academy? *

Josh the Otter Event

Search Engine

Social Media

Preschool

Referral from a friend (please type friend's name in space provided) Referral from a friend (please type friend's name in space provided)

7. If you have additional information or would like to request something not mentioned on this form please use this section.

Participation Agreement

I, ________________________ (fill in your name here) *

as parent or guardian, give permission for my child ______________________ (your child's name here) *

to participate in aquatic activity. My child is in good health and physical condition, and is not suffering from any conition that would prevent him/her from engaging in this activity.

Please read carefully and be aware that in registering your minor child for participation in this program, you will be waiving and releasing all claims for injuries you or your child might sustain as a result of participation in any class or activity conducted by Little Otters Swim Academy, Tina Baron, Independent Swim Instructor. As a parent/guardian of a participant in Little Otters Swim Academy/Tina Baron's swim lessons, I recognize and acknowledge that there are certain risks associated. I agree to assume full responsibility of any injuries, property damage, or loss, which I, or my minor child, may sustain as a result of participating in any and all activities connected with or associated with these lessons. I agree to indemnify and hold Little Otters Swim Academy, Tina Baron harmless from any liability resulting from the use of premises and waive and relinquish all claims against Little Otters Swim Academy, Tina Baron and the pool owners that I or my minor child may sustain as a result of participating in any swimming program offered by Little Otters Swim Academy, Tina Baron. I have ready and fully understand the above waiver and release of all claims, and it shall not be modified orally.

Signature of Parent/Legal Guardian * 🛈

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Printed Name of Parent/ Legal Guardian *

Date * +

Photo/Videography

Photographs and video (many of which are underwater) may be taken in conjunction with lessons by your Instructor. Video use is for training and review to improve your child's lessons. I (parent/guardian) understand and agree that this media may be used for informational and advertising purposes. Whenever possible those photos and videos will be shared with parents.

I (parent/guardian) agree that I will not post personal videos or photos on any social media site without the permission of Tina Baron, Little Otters Swim Academy.

I (Parent/Legal Guardian) agree to these photo/video terms *

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Financial Agreement

Registration Fee

There is a one-time Registration Fee of $35 per student/$70 max per family, due at the completion of this form.

Weekly Fees

*If you are traveling to me at one of my provided "host pools" your weekly tuition fee is $85. Siblings are $75 per week.

*If you are hosting additional children (other than your own) at your home pool, discounts will apply and your registration fee will be waived.

*If I travel to your home for private lessons for your children, there will be an additional $50 weekly trip charge. If you are more than 5 miles from downtown Oviedo or outside of my current travel area, an additional mileage charge will be applied based on the number of miles.

*Maintenance/Stroke/Snorkel lessons will be booked in a series of 2 per week (minimum). These lessons are scheduled in the same manner as your original series. Weekly fees will be based on where these lessons are to take place.

Weekly fees are due on MONDAYS

When paying poolside: You may pay with a check (payable to Tina Baron) or cash. Please place your payment inside an envelope (provided) with your child's first name and last initial on the outside with the date. Place this envelope inside my binder in the clear zipper case labeled "payment".

Returned check fee is $40.

Automated payments are also gladly accepted. Due on Mondays.

Pay pal: baron_tina@yahoo.com (friends and family)

Venmo: @Tina-Baron-2

Parent/Legal Guardian Signature agreeing to financial terms * 🛈

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Almost Finished ...

Thank you for taking the time to complete the New Student Registration. Please complete your form by paying your registration fee below.

The next steps are:

1. After this form submission you will get a confirmation email with a link for your Lesson Guidelines. Please download, print it if possible, and begin reading. This will better prepare you for what to expect with these lessons.

2. Order your swim diaper and warm belly wet suit (if needed). All children aged 3 and under must wear a nondisposable swim diaper that does not have snaps or velcro. Please see the previous page for ordering information

You will be contacted with a target schedule date and time. In the weeks before your child's lessons are to start you will receive a confirmation of this. If you need clarification or would like to discuss this further, please call or email.

Thank you and I look forward to meeting you and teaching your child to be safer in and around the water!

Registration Payment

Please complete the registration by paying a one-time registration fee. After selecting the "next" button below you will be redirected to PayPal.

One Child Registration ($35.00)

Third Sibling (0.00)

Host Pool (0.00)

Scholarship (0.00)

Wait List (0.00) Your registration fee of $35 will be due immediately when you are offered and accept a time slot

Please hit the "Next" button below to complete. If applicable you will be redirected to Paypal! Thank you.