Test Reg – Simple Pick – Dominion Hills Pool

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Swim Lesson Registration 2022

Swim Lesson Registrations for the 2022 season.

"*" indicates required fields

Parent / Guardian's first and last name*

I am a DHARA Member*

Please indicate if you are a current member of the Dominion Hills Recreation Association in good standing.

Member Number*

Parent/Guardian Email*

Enter Email Confirm Email

Parent/Guardian Mobile Phone*

Child's First and Last Name*

Child's Swimming Level*

Choose the swimming level for your child, 1 through 4. Level 1 being a new swimmer.

Swim Session*

Select a session to attend

Session 1 & 2 Time Slot Preference*

Preference 1

Preference 2

Preference 3

Session 3 & 4 Time Slot Preference*

Preference 1

Preference 2

Preference 3

Do you have siblings enrolled in DH Swim Lessons?

Please indicate how many total children you have enrolled in DH swim lessons. NOTE: Each enrollment must be done individually.

Subtotal

$0.00

COVID-19 Hold Harmless Agreement*

COVID-19 Hold Harmless Agreement

An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and individuals with underlying medical conditions are especially vulnerable.

By entering the premises of DHARA, I voluntarily assume all risks related to exposure to COVID-19. With full awareness and appreciation of the risks involved, I hereby waive and release DHARA and/or any member of the DHARA Board of Directors from any claim of liability, harm, injury, illness or death which may arise directly or indirectly from exposure to COVID-19 while on the premises of DHARA.

I agree to the Terms of Service

Consent Form*

By signing this form, you state your confidence that your child/children can accomplish the minimum skill required of the level. If said child/children cannot perform the minimum requirement of the group signed up for, it cannot be guaranteed that a lower-level class will have available slots. A child will not, under any circumstance, be permitted to stay in a class in which they do not have the necessary entry-level skills.

INCLEMENT WEATHER: Due to inclement weather your lesson may be canceled. Cancellation may be declared any time prior to, or during your lesson. The best way to obtain cancellation information is to contact the pool or one of our managers. We will attempt to make up classes by adding 5-10 minutes at the end of each lesson or will reschedule the lesson for a Friday or Saturday. Make-up classes will be communicated via email.

IMPORTANT INFORMATION TO ALL REGARDING NON-MEMBER POOL USAGE AND SWIM LESSONS: Other than the student in the assigned lesson, ALL non-members or those who are not paid guests of a DHARA member, are NOT permitted to use the pool at any time. Anyone who fails to comply with the DHARA pool rules or otherwise misuses the pool will be asked to leave the premises and may be prohibited further in the swim lesson program. All swim lesson fees are non-refundable.

I agree to the Terms of Service

Total

Would you like to pay by Credit Card or Check?*

Pay By Check*

When paying by check, payment must be received prior to, or at your swim lesson session. Checks should be made out to DHARA and mailed to:

DHARA Swim Lessons
6000 Wilson Blvd
Arlington, VA 22205

By checking this box you recognize that failue to pay may result in the loss of any reserved slots in a session.

I agree to the pay by check policy.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Test Reg – Simple Pick

Swim Lesson Registration 2022

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