want to sign up?
Fill out the appropriate forms for your class below. After submitting your forms, contact our office to secure your spot in class.
Submitting these forms does NOT guarantee enrollment. Contact our office to confirm availability.
Child Liability Form
Adult Liability Form
SUBMITTING REQUIRED FORMS DOES NOT GUARANTEE A SPACE IN CLASS
CONTACT THE OFFICE TO CHECK ON AVAILABILITY
These forms can be submitted online, printed, or completed in person at our facility.
In addition to a liability waiver, all students enrolling in the Aquatics program must complete the Aquatics registration and waiver before starting class. This form can be submitted online or printed and returned to Break the Barriers’ front office.
Sometimes a doctor’s release is required to participate if a student has specific physical or medical conditions such as (but not limited to) heart conditions, epilepsy, or bone and joint issues. Please contact us if you have questions about specific medical conditions.
There are three different releases we use:
If you are a Veteran and interested in taking free classes at Break the Barriers, please print and complete this registration packet. For Release form, please go to Primary Care Physician at VA and request a Recreation Therapy Consult from either Andrea Hernandez or Antonio Cuyler. At consultation ask to participate at Break the Barriers. *If you are not going through VA, have your personal Primary Care Physician sign the Release form.