2024 Returning Student Update

Welcome back! I can't wait to see how much your sweet Little Otter has grown and hear all about their fabulous adventures since our last swim together!

Participant Information

Student's First Name

Last Name

Gender

Birth Date +

Parent/Guardian Contact Information

Please select *

Parent's First Name *

Last Name *

Cell Phone

Please select *

First Name *

Last Name *

Cell Phone

Address 1 *

City *

State *

Zip *

Primary Email Address *

If someone other than you (i.e. other parent, grandparent, or nanny) is bringing your child to the pool please give his/her name, phone number and email. Please share all guidelines and directions with them, so that we are able to effectively communicate.

Since the last series of swim lessons has your child experienced any of the following:
Seen a specialist other than your regular pediatrician?
Lost consciousness?
Been revived via CPR?
Had a seizure of any kind? (febrile seizure included in this response please)
Had a "breath holding" incident?
Had a kidney or bladder infection?
Required the attention of a medical specialist or health care provider other than pediatrician or family doctor?
Taken medication for longer than 2 weeks?
Experienced any recurrent respiratory problems?
Had any surgery, other than circumcision? *

yes

Since the last series of swim lessons has your child experienced any of the following?
Hospitalized for head injury?
Treated in emergency room?
Diagnosed with heart murmur?
Had a fever for longer than 5 days?
Treated for ear infection?
Diagnosed with allergies?
Prescribed an EPI pen?
Chronic bouts of diarrhea or constipation?
Around smokers on a daily basis?
Accidentally fallen into water? *

yes

Did you answer yes to any of the questions above? If so please explain in the box below.

If you answered yes to any of the above questions we may need a doctor's note releasing your child for swimming lessons. Please be prepared that this could delay our lesson start.

How long has this child been out of the pool since last performing swim-float-swim or roll-to-float? *

Since the last series of lessons has your child had an accidental fall into the pool? If yes, please provide a short description of what transpired. If no, please write none in the box. *

What are your goals for your child with this series of lessons? *

What is your preferred lesson time? *

7am-9am (travel pools primarily June to August)

9am-1pm (host pools)

1pm-3pm (host pools)

3pm-5pm (host and travel pools-April and May only)

Where would you like swim lessons to take place? *

My home pool (water temp is over 83)

Instructor provided Host Pool

I am interested in hosting lessons at my home pool

Other Other

What is your preferred start date? Please keep in mind your school/summer camp schedule. Also if you want lessons to take place at your home pool the water temperature must consistently be over 83 degrees for 2 weeks prior to our lesson start. *

Anything else to add? Any requests or anything you would like to discuss?

Participation/Financial/Photography Agreement

I ______________________ (parent/guardian name) *

give permission for my child, _______________________ (child's name) *

to participate in this 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 or 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.

FINANCIALS

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

*If I am traveling to YOU for private home lessons with ONLY your children there will be an added $50 trip charge. An additional mileage fee may apply if you are more than 5 miles from downtown Oviedo or out of my current travel area. Please consider sharing your pool for substantial discounts, and or free lessons.

*Maintenance/Stroke/Snorkel lessons will be booked in a series of 2 per week (minimum) and charged @$20 per lesson

Weekly fees are due on Mondays, before the scheduled lesson time.

If you are paying poolside, you may pay by check or cash.

Checks payable to Tina Baron.

Please include your child/children’s name and the dates(s) of the lesson(s). Please use a blank envelope to keep your information private and note the child's first name. Then place cash/check in my binder in the payment zippered case

You may prepay electronically

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

Venmo @Tina-Baron-2

Thank you

PHOTOGRAPHY and VIDEOGRAPHY

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

Photographs and video may be taken by Tina Baron in conjunction with 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.

Printed name of Parent/Guardian *

Parent/Guardian Signature, indicating agreement to the above terms * 🛈

clear

Todays Date * +

Thank you for taking the time to update me on your child. I will do my very best to honor your time request. I will ask for your patience, as I secure host pools and insure the water temperature is consistent and acceptable for teaching. Thanks again!! Tina

Refresh/Refine previously learned skills	Swim-Float-Swim
Stroke Work (Free, Back, Breast, Fly)	Snorkeling
More confidence with skills