Please fill out the online enrollment form below and someone will contact you within the next 48hours. 

Participants Name *
Participants Name
Participant's Date Of Birth *
Participant's Date Of Birth
Enroller's Name (If different than participant) *
Enroller's Name (If different than participant)
Mailing Address
Mailing Address
Phone *
Phone
Desired Start Date
Desired Start Date
Desired Time
Desired Time
Emergency Contact *
Emergency Contact
We'd love to learn how you heard about our service
Insurance: It is the responsibility of every individual, their parent or legal guardian, to provide for their own accident and health coverage while participating in Waterbug Aquatics & Aquatic Fit’s activities. Waterbug Aquatics & Aquatic Fit does not provide any such coverage for its participants. Authorizations and Release Photograph Permission: I give permission for the Waterbug Aquatics & Aquatic Fit to use any pictures of my child for future promotional purposes. I grant to Waterbug Aquatics & Aquatic Fit, the right to take photographs of me and my family. I authorize Waterbug Aquatics & Aquatic Fit, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Waterbug Aquatics & Aquatic Fit may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. Medical Treatment: I hereby give permission for my child to be given cardiopulmonary resuscitation (CPR) and First aid treatment by a qualified staff member of the Waterbug Aquatics & Aquatic Fit. In the event I cannot be contacted, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures (including, but not limited to, administration of necessary anesthetics, tests, x-ray examinations, transfusions, injections, drugs) to be performed for my child by a licensed physician or hospital selected by the Waterbug Aquatics director when deemed immediately necessary or advisable by the physician to safeguard my child’s health. Release from Liability: Recognizing that Waterbug Aquatics & Aquatic Fit will do its best to ensure a safe experience, I understand that accidents may occur both from my child’s participation in youth sports activities and from transportation to and from the program. I agree to assume these risks. By signing below, I release the Waterbug Aquatics & Aquatic Fit, its employees, volunteers, independent contractors, directors and agents from all liability based on any damage, loss or injury whether it is the result of ordinary negligence or otherwise, caused to my child or to me. I have read and understand the above and have completed this form to the best of my ability. I also support Waterbug Aquatics & Aquatic Fit’s philosophy listed on their websites. 1. I, the applicant wish either for myself or my child to utilize the services, facilities, swimming pool, and/or fitness programs offered by Waterbug Aquatics & Aquatic Fit Inc. 2. I hereby agree that the use of the services, facilities, swimming pool, and/or programs is at my child’s (if applicable) and my own risk. As a condition of my and my child’s (if applicable) use of such services, facilities, swimming pool and/or fitness programs. I on behalf of myself, my heirs and assigns and my child (if applicable) expressly agree to forever discharge, waive and release Waterbug Aquatics & Aquatic Fit Inc, its owners, management, staff, servants, agents, employees and/or independent contractors and their heirs, successors and assigns from any and all claims, demands, injuries, damages, actions, or courses of action, and from all acts of active or passive negligence on the part of Waterbug Aquatics & Aquatic Fit Inc, its owners, management, staff, servants, agents, employees and/or independent contractors that I or my child (if applicable) may have or acquire against Waterbug Aquatics & Aquatic Fit Inc, its owners, management, staff, servants, agents, employees and/or independent contractors on account of bodily injury, mental injury and/or property damage from, any mishap, accident, loss, damage or injury suffered by my child (if applicable) or myself or others resulting from , connected with or caused by the use of Waterbug Aquatics & Aquatic Fit Inc’s services, fitness programs, swimming pool and /or facilities whether located on or off the Waterbug Aquatics & Aquatic Fit Inc premises, including, but not limited to any injury resulting from mechanical defects or failure of any equipment or devices used in such services, programs, swimming pool or facilities. I further agree to defend, indemnify and hold harmless Waterbug Aquatics & Aquatic Fit Inc, its owners, management, staff, servants, agents, employees and/or independent contractors, their heirs, successors and assigns from any and all claims, losses or liability arising from, connected with myself or my child’s (if applicable) use of Waterbug Aquatics& Aquatic Fit Inc’s services, fitness programs, swimming pool and facilities, whether located on or off the Waterbug Aquatics & Aquatic Fit Inc. premises. 3. I declare and affirm that myself or my child (if applicable) am (or are) in good medical and physical condition and that the use of the Waterbug Aquatics & Aquatic Fit Inc. services, facilities, swimming pool and/or fitness programs does not pose any danger to my or my child’s (if applicable) health. I also certify that I have disclosed any pertinent Medical History on my registration form so the owner and instructor (s) are aware of any condition (s). 4. I agree that I and my child (if applicable) will abide by all the rules and regulations of Waterbug Aquatics & Aquatic Fit Inc. These rules may be amended at Waterbug Aquatics & Aquatic Fit Inc’s discretion. I agree that I and my child (if applicable) will not engage in behavior injurious to the enjoyment of Waterbug Aquatics & Aquatic Fit Inc or other participants. I understand and agree that my and my child’s (if applicable) use of Waterbug Aquatics & Aquatic Fit Inc’s services may be immediately terminated if my (or their) behavior is not in accordance with the above. I have read and understand the foregoing, and acknowledge my consent to the terms of this Waiver and Release for myself and my child (if applicable) by signing the Agreement. By submitting this form I am also submitting my signature accepting all terms and conditions in the waiver above.