Rock Port City Pool Private Lessons

Please complete the following fields of the registration/permission webform for your child to take private lessons with a certified lifeguard at the Rock Port City Pool.

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Participant Name *

Birth Date *

Parent/Guardian name *

Email *

Phone *

Alt Phone

Emergency Contact *

Emergency Contact Phone *

Medical History *

Please list any medical conditions or concerns the guard should be aware of (e.g. allergies, diabetic, anxiety, etc..)

Other Comments

Signature *

I give permission for the above mentioned participant to participate in the private lessons held at the Rock Port City Pool. I understand that the volunteers and staff at the Rock Port Pool will not be held responsible in case of accidents. If I am not present in case of an emergency, I understand volunteers at poolside may choose to contact 911 before parents are notified. I understand all pool rules will apply during lesson periods and it is my responsibility to know those rules. No one under 8 years old is to be at the pool without parental supervision. Volunteers and pool staff are not responsible for children left without parental supervision in the park, playground or parking lots. Except for the pool staff and the children having their lessons, no one is to be in the pool. Please do not let your child beyond the bath house until the lifeguard giving lessons is ready. Your cooperation and understanding are much appreciated. By providing your digital signature below, you are agreeing to the guidelines and expectations previously stated.

Rock Port City Pool Private Lessons

Contact Information

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Phone/Fax

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Rock Port City Pool Private Lessons

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Contact Information

Address

Phone/Fax

Office Hours