Valley Isle Aquatics Registration Form

Session: Oct-Dec~2013 (Community Pools)

Class Dates, Times, & Location (s): Please see Class Information page for details.
Number of Lessons: Dependent upon the pool location.
*30 minute classes
Session Cost: Dependent upon the pool location and dates of classes.

*Please remember we charge a very nominal fee for our lessons; and each session's budget is determined by the number of enrollees. We hold your swimmer's place in class for each date of the session and cannot fill that spot for just one class date, therefore we cannot issue refunds for missed classes; we cannot carry over balances from one session to another session; and participants cannot pick and choose the dates they wish to attend. Please review the Make-up Policy for further details.
*All payments and class registrations MUST go through our website; if not, they are NOT valid classes; and Valley Isle Aquatics may NOT be held liable.

If you are using the mobile site please be aware that many of the pages are not yet functioning or rending properly. Please complete all registrations on our full site.

Note: Items marked * are required

Personal Details

1. Student's First Name*
2. Student's Last Name*
3. Both Parent's/Guardian's First Name*
4. Both Parent's/Guardian's Last Name*
5. Email Address
   *
   
*Please do provide your email as this is our only way of sending you a confirmation email.
6. Student's Age*
   
7. Student's Birthdate*
8. Student's School & Dismissal Time*

Gender

1. Gender*    Female Male

Address Details

1. House Number & Street*
2. Town/City*
3. State*
4. Zipcode*
5. Home Phone*
6. Cell Phone * Text Message Yes No
7. Work Phone*

Payment Details

Please complete the following items according to your account information which you are using to make your payment. This will assist us in matching your payment with your registration form. You do NOT need a PayPal account!

1. PayPal or Payment Account Name*
                    *Important if using a different account name than the registration name.
2. Email Address (PayPal or Payment)*
3. Company Name (if paying via company account)*

Please check the box for the location, time, and level class you are registering.
We are only offering classes, times, and levels that are listed.
Please do NOT submit a blank registration form; this only delays the process and does NOT guarantee your child a space in the class.
Your child will NOT be enrolled in a class until your payment and completed registration form is received AND you receive a confirmation email from us.

Facility

1. Facility*
   Kokua Pool Wednesdays Kokua Pool Sundays
   Pukalani Pool Thursdays Pukalani Pool Saturdays

Oct-Dec 2013

	KP= Kokua Pool              *Adult lessons: best on Wednesdays & Thursdays~please call us to make arrangements   PP=Pukalani Pool
Location	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Red	2:00 KP			1:00 KP	PP		2:00 PP
Red-Orange	2:35 KP			1:30 KP	PP		2:35 PP
Orange	3:10 KP			2:00 KP	PP		3:10 PP
Orange-Yellow	3:45 KP			2:30 KP	PP		3:45 PP
Yellow	3:45 KP			230 KP	PP		3:45 PP
2-3 year olds
Parent-Child

I give my consent/permission to Valley Isle Aquatics to use my child's picture/image.  Full Policy
I do NOT give my consent/permission to Valley Isle Aquatics to use my child's picture/image.
Submitting this registration form does NOT guarantee you a spot in the class.
Please be aware that classes with fewer then four (4) students will be CANCELLED!
There are NO REFUNDS.
Read the full Refund and Cancellation Policy.
By submitting this registration form, you agree with the terms listed below.

*Please remember we charge a very nominal fee for our lessons; and each session's budget is determined by the number of enrollees. We hold your swimmer's place in class for each date of the session and cannot fill that spot for just one class date, therefore we cannot issue refunds for missed classes; we cannot carry over balances from one session to another session; and participants cannot pick and choose the dates they wish to attend. Please review the Make-up Policy for further details.
*All payments and class registrations MUST go through our website; if not, they are NOT valid classes; and Valley Isle Aquatics may NOT be held liable.

Valley Isle Aquatics  PO Box 367  Haiku, HI 96708  (808) 572-4665
valleyisleaquatics@valleyisleaqutics.com
(C)2008-2013            Designed by Maui Tech Girl

Below pertains to only Community Classes in Maui County public pools

County of Maui
Department of Parks & Recreation
Community Classes

The County of Maui does not discriminate on the basis of disability in admission, access to,
or operation of its programs, service, or activities.
The County of Maui does not discriminate on the basis of disability in its hiring or employment practices.
We are committed to making all of its programs and leisure services accessible to everyone including persons with disabilities.
Do you have need for reasonable modifications? _____ Yes _____ No
Question, concerns, complaints, or requests for additional information regarding compliance
with the Americans with Disabilities Act may be forwarded to:
Community Courses Office
Tara Sabado
700 Haliÿa Nakoa Street #2
Wailiku, HI 96793
(808) 270-7383 voice
tara.sabado@co.maui.hi.us

Release and Covenant Not to Sue
In consideration of the permission granted to me by the Department of Parks and Recreation of the County of Maui,
State of Hawai'i, to attend or participate in the above described a"Calibri"ctivity
>I, the undersigned, hereby release the above named Instructor and the County of Maui, its officers and employees,
from all actions, causes of action, damages, claims, or demands which
I, my agents, successors, assigns, heirs, executors or administrators, may have against said Instructor or the County of Maui,
its officers and employees, for the property damage and personal injury, including but not limited to
claims for wrongful death, known or unknown, which may be
sustained or incurred by my attendance or participation in the above described activity.
I also covenant, on behalf of myself and my agents, successors, assigns, heirs, executors or administrators,
to never institute any legal action against said Instructor or the County of Maui,
its officers and employees, or in any way aid in the prosecution of
any claim or action for damages, costs, loss of services, expense or compensation,
arising our of my attendance or participation in the above-described activity.
I, the undersigned,
have read this release and Covenant Not to Sue
and understand all its terms. I execute it voluntarily and with full knowledge of its significance.
If you have special needs, please read and complete the Inclusion Form.