Private Swim Lesson Payment Form

Please only fill this form out if your private swim lesson enrollment has been confirmed by the Aquatics Director.

Child's Full Name(Required)

First Last

Child's Birthday(Required)

Child’s Birthday

Parent / Guardian's Full Name(Required)

First Last

Parent / Guardian's Cellphone(Required)

Parent / Guardian's Email(Required)

Emergency Contact's Name(Required)

First Last

Emergency Contact's Relationship to Child(Required)

Liability Waiver(Required)

I agree to the Liability Waiver

By checking this box, I release, hold harmless, and indemnify the Kaiserman JCC and the Jewish Federation of Greater Phila, as well as it’s agents and employees, from and against any liability on their part, of any kind whatsoever, which may arise in any manner, from use of the JCC’s facilities.

Pool Rules(Required)

I agree to the Pool Rules

• I understand all classes are non-refundable and non-transferable.
• For your safety, swimming is not permitted unless there is a lifeguard on duty.
• No food or drink allowed inside the swimming pool.
• No glass containers permitted on the pool deck.
• Swimmers must wear appropriate bathing attire in the pool.
• Lap lanes are for Lap Swimmers only; please use the circle swim pattern.
• No holding on to or sitting on the lap lane ropes.
• No roughhousing, holding under water, pushing, throwing or hitting other swimmers.
• Lifeguards may limit the number of toys and floats allowed in the pool.
• Children who wear a Personal Flotation Device (PFD) in the large pool must have an adult in the water within arm’s reach at all times.
• Children 7 and under must be accompanied IN the water by an adult (minimum of 18 years old) while in Main Pool.
• Children ages 8-12 must be accompanied by an adult outside at the Swim Club.
• Children must be 13 years old to be alone at the Swim Club.
• All children 17 and under must pass a Deep End Swim test to enter the deep end. Swimmers who pass the Deep End Test will be given a wristband. Swimmers who do not pass or choose not to take the test must remain in the shallow end of the pool.
• The Toddler Pool is for children 6 years old and younger.
• Infants and children who wear diapers are not permitted in the Main Pool.
• Infants and children who are not toilet trained, must wear a swim diaper covered by separate rubber/vinyl pants, all of which must fit snugly around the legs and waist. In addition, appropriate swim attire must be worn over top the rubber/vinyl pants in the Toddler Pool.
• I consent to emergency care of me or my family by JCC staff, agents or health care providers in accordance with their best judgement.
• I agree that it is my responsibility to provide insurance to cover injuries arising from participation in JCC activities or programs.

Private Swim Lesson Payment(Required)

Private Lessons ($210)

Total

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Email (For Receipt)(Required)

Credit Card(Required)

Card Details

Cardholder Name

Login to Kaiserman JCC

Private Swim Lesson Payment Form

Private Swim Lesson Payment Form

weekly schedule