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Fundamentals of Instructor Training Course (FIT)

Valley Isle Aquatics Wonderful Wednesdays Registration Form

Valley Isle Aquatics
Swimming for Life Registration Form

Session: Spring Blast-Off

Session Dates: 4/17, 4/24, 5/1, 5/15, 5/22, 5/29
Cost: $96.86 includes tax & fees

Please check the box for the 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 spot 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.

Times	Preschool Level Red	Preschool Level Red-Orange	Preschool Level Orange	Level Red	Level Red-Orange	Level Orange	Level Orange-Yellow	Level Yellow	Level Yellow-Green	Level Green	Middle School	Parent-Child	Adult
10:15 am
11:15 am
12:15 pm
1:15 pm
2:15 pm
3:15 pm
3:10-3:40 pm
3:40-4:10 pm

Please be sure to delete the information in the box prior to typing your information.

Email:
*Please do provide your email as this is our only way of sending you a confirmation email.

Student First Name:

Student Last Name:

Student Age:

Student Gender:

Parent First Name:

Parent Last Name:

Address:

City:

State:

Zip:

Home Phone:

Cell:

Business:

PayPal Account Name:

*Your PayPal Account Name is essential for us to match the registration form and payment.

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.

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:
Aunty Ti
700 Haliÿa Nakoa Street #2
Wailiku, HI 96793
(808) 270-7979 voice
(808) 270-5539 fax
karen@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 activity 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.

Valley Isle Aquatics

Valley Isle Aquatics PO Box 367 Haiku, HI 96708 (808) 572-4665 or (808) 269-4166
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