Break the Barriers

Aquatics Registration Form

Registration Form

Aquatics Registration Form

Welcome to Swim at Break the Barriers!

Come to Break the Barriers to register

We are excited to have you improve your swimming abilities. Lessons for all ages and levels are offered, including Baby & Me/Toddler & Me and Privates classes.

New Student BTB Aquatics registration fee: $35

"*" indicates required fields

Student and Class Information

How many students are you registering?*

Please enter a number from 1 to 6.

Child 1

Relationship to the student*

Parent

Foster Parent with Exparte

Legal Guardian with court papers

Foster Parents and Legal Guardians must provide BTB with the appropriate documents one week before starting class. Students cannot begin class without appropriate documents.

Swimmer Name*

Age*

Gender*

New or Returning?

Class Type (Group, Private, Elite, Basic Water Rescue Certification)

Student Health History (Check all that apply)*

Child 2

Relationship to the student*

Parent

Foster Parent with Exparte

Legal Guardian with court papers

Foster Parents and Legal Guardians must provide BTB with the appropriate documents one week before starting class. Students cannot begin class without appropriate documents.

Swimmer Name*

Age*

Gender*

New or Returning?

Class Type (Group, Private, Elite, Basic Water Rescue Certification)

Student Health History (Check all that apply)*

Child 3

Relationship to the student*

Parent

Foster Parent with Exparte

Legal Guardian with court papers

Foster Parents and Legal Guardians must provide BTB with the appropriate documents one week before starting class. Students cannot begin class without appropriate documents.

Swimmer Name*

Age*

Gender*

New or Returning?

Class Type (Group, Private, Elite, Basic Water Rescue Certification)

Student Health History (Check all that apply)*

Child 4

Relationship to the student*

Parent

Foster Parent with Exparte

Legal Guardian with court papers

Foster Parents and Legal Guardians must provide BTB with the appropriate documents one week before starting class. Students cannot begin class without appropriate documents.

Swimmer Name*

Age*

Gender*

New or Returning?

Class Type (Group, Private, Elite, Basic Water Rescue Certification)

Student Health History (Check all that apply)*

Child 5

Relationship to the student*

Parent

Foster Parent with Exparte

Legal Guardian with court papers

Foster Parents and Legal Guardians must provide BTB with the appropriate documents one week before starting class. Students cannot begin class without appropriate documents.

Swimmer Name*

Age*

Gender*

New or Returning?

Class Type (Group, Private, Elite, Basic Water Rescue Certification)

Student Health History (Check all that apply)*

Child 6

Relationship to the student*

Parent

Foster Parent with Exparte

Legal Guardian with court papers

Foster Parents and Legal Guardians must provide BTB with the appropriate documents one week before starting class. Students cannot begin class without appropriate documents.

Swimmer Name*

Age*

Gender*

New or Returning?

Class Type (Group, Private, Elite, Basic Water Rescue Certification)

Student Health History (Check all that apply)*

Any information about your child/children that the coach should know?

Parent / Guardian Name*

Parent / Guardian Email*

Parent/Guardian Best Phone Number*

Parent/Guardian Signature*

Date Signed*

Aquatics Rules Waiver

We are excited to meet your swimmer and to work with them to improve their swimming abilities!

These are a few rules we want our Aquatics families to be aware of and that will enhance your swim experience.

Dress Code and Pool Rules

All Swimmers under age 3 years old : are required to wear a tight fitting reusable cloth swim diaper. Swimmers 3 and older that are working on bathrooming are also required to wear a tight fitting reusable swim diaper for the integrity of the pool.
G-tube/Mic-Key tubes: tubes must be 3 months matured before they are allowed to swim. Swimmers with G-tubes will swim in the small pool.
No Sunscreen/Lotion: Our new facility is indoors, we ask that your student comes without sunscreen or lotion on their skin. Please have your student rinse off in the showers before entering the pool.
One-Piece Bathing Suits: Mandatory for all female students, including parents.
Tie Back Long Hair: It is mandatory for all swimmers with long hair who are in LTS3 and above to wear a swim cap. If your swimmer is in a lower level we ask that their hair is tied back; swim caps are optional.
No Running & No Diving: Safety is one of our top priorities around the pool and as a safety requirement we request that you walk around the pool deck and only enter the water feet first.
Supervise your child at all times: Our coaching staff’s number one priority is for the safety of all swimmers so we ask you to keep an eye on them too. In partnership with Dr. Mike Allshouse and Valley Children’s Hospital we are a no cell phone zone and request that you refrain from using your cell phone during your child’s swim class unless you are taking pictures of your swimmer. Please be attentive to your swimmer before, during, and after class.

Class Structure: At the beginning of each class students will be taught an American Red Cross safety topic that will educate them on how to be safe in and around the pool. After this they will start their lesson with a review of skills previously mastered and then begin learning new skills or techniques that will improve their swimming abilities.

Parent Involvement: At BTB we encourage all parents to watch their students lesson but not involve themselves in the lesson unless requested to do so by the coaching staff. Most students respond best if they are consistently given directions from one person, that being the coach for the class time. If you need to communicate with the coach please ask to speak with the coach or swim director after class.

No Make Ups

There are no make ups for classes you have missed. In the event that BTB has to close the pool the Aquatics Director will contact you regarding a makeup class.

I have read the above information regarding Make Ups (initial)*

Enrollment

All classes require a minimum of 3 students. If less than 3 swimmers are enrolled, swimmers will be transferred to another class in an effort to retain our staff. If you want to continue in your current day and time the fees will be changed to reflect a private lesson. Students’ levels are subject to change based on their age and ability.

I have read the above information regarding Enrollment (initial)*

Safety

If a student begins coughing excessively during class, which could cause them to ‘throw up’ (because of drinking the water, inhaling water through their nose) they will be required to sit out on the side of the pool with the lifeguard for a short time period. This is for the safety of all swimmers to ensure that we can continue swimming.

I have read the above information regarding Safety (initial)*

Refunds

There are non refunds on Swim fees paid

I understand that there are no refunds for BTB Swim (initial)*

Class Experience

A child may be transferred to an appropriate level/private lessons per the swim director for a successful experience.

I have read the above information regarding class experience (initial)*

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