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Participant Information:
Participant Name: _____________________________ Birth Date: __________________
Circle one: Male Female
Street Address:__________________________________________________________________
City: ______________________________ State: ________ Zip: ________________
Telephone: ______________________________ Mobile:__________________________________________
Email Address: __________________________ Parents Name(s): __________________________________
Policies:
1. DS reserves the right to cancel programs if minimum number of participants is not met.
2. Registration is accepted on a space available basis.
3. Refunds will not be given for programs cancelled by participant. Program staffing is based on the number enrolled.
4. Make-up lessons are ONLY given for classes cancelled due to inclement weather.
How to Register:
1. Complete the appropriate sections on the registration form.
2. Each individual participant must fill out a registration form and pay for the lesson prior to start of classes. Additional
registration forms can be picked up at DS Recreational Services or you may download them from our website at
www.dsrec.com.
3. Return Registration Forms to DS Recreational Services in person, by mail or fax your form to 281.443.1524. If you are
faxing, please call to confirm your fax was received.
I/We, understand that DS Recreational Services, Inc., its staff members and the contracted organization where programs are held
cannot be held liable for injuries while at the program location or otherwise under the supervision of its staff members. Knowing
that DS Recreational Services, Inc. will do its best for the safety of its clients, I/We assume all responsibilities and waive any
claims that may arise from any injury while participating in the swimming lessons.
Signature of Student or Parent (If Student is Under 18 years of Age) ___________________________________ Date ____________
Payment Method
Number of Lessons Purchased:_______________ Rate per Lesson: $_____________+ $12.00 Reg. Fee TOTAL:__________