& SEASONAL SWIM CLINIC The swimming season starts now! Regency Sport&Health is proud to present USA Swimming Coaches Jo Vera & Art Vera in small group swim clinics beginning in January! Clinics are 8 weeks in length, and have a maximum 6:1 student:teacher ratio. CLINIC SESSIONS: (Pricing displayed is for Tuesday OR Saturday OR Sunday options.) Sundays - January 4, 11, 18, 25, February 1, 8, 15, and 22. *Catch all make up on March 1. -- OR -Tuesdays - January 6, 13, 20, 27, February 3, 10, 17, and 24. *Catch all make up on March 3. -- OR -Saturdays - January 10, 17, 24, 31, February 7, 14, 21, and 28. *Catch all make up on March 7. CLINIC PLACEMENT: Students MUST complete a FREE swim assessment. ORCA (Ages 5+) - Must be comfortable in water and able to submerge underwater. Class aimed at learning a length of Freestyle, with bilateral breathing, and Backstroke. /TUESDAYS @415-5pm -OR- SATURDAYS @8-845am-OR- SUNDAYS @330-415pm; @4:15-5pm MAKO (Ages 7-10) - Must be able to swim 25 meters Freestyle & Backstroke and ready to try all 4 strokes. Class aimed at learning the fundamentals of the four competitive strokes. /TUESDAYS @5-6pm-OR- SATURDAYS @10-11am -OR- SUNDAYS @5-6pm SWORDFISH (Ages 10+) - Must be legal in at least 3 strokes and ready to learn advanced competitive/lifelong swimming techniques. /TUESDAYS @6-7pm -OR- SUNDAYS @6-7pm CONTACT COACH JO FOR YOUR FREE ASSESSMENT TODAY! ForMembers: more information or to register, Cost: $350 Nonmembers: $390 visit sportandhealth.com/programs or contact: For more information please contact: Aquatics Director: Jo Podlasek Vera Program Director: Phone: 703-402-6104 Email: [email protected] Date: Tuesdays OR Sundays OR Saturdays, See Above Time: See Above Location: Regency Sport&Health Sorry, refunds or make-up days are not available for missed classes. However, if the club cancels the class, then either a make-up day or credit will be offered. If you have an injury and a physician’s note, a credit will be given to your account. Program schedules may change or be cancelled due to low enrollment. Keep in touch with us on social media! Like us on Facebook at facebook.com/RegencySportAndHealth sportandhealth.com PROGRAM REGISTRATION FORM Club Name: ____________________________________________________________________________________________________ Participant’s Name _______________________________________________________________________ ! Member ! Nonmember Home Phone _________________________ Work Phone ___________________________ Cell Phone __________________________ Email __________________________________________________________________________________________________________ Address ________________________________________________________________________________________________________ City________________________________________________________________________ State__________ Zip_________________ PAYMENT Program Name ______________________________________________________________________________________________ Start Date __________________ End Date_________________ Start Time __________________ End Time__________________ Total Amount $__________________________________ Type of Payment: ! Cash ! Check (# __________ ) ! Credit Card ! Card on file Signature: _________________________ Date:_________ ! I authorize Sport & Health Clubs, L.C., to auto-charge the credit card currently on my account. RELEASE: Participant understands that engaging in Club programs and activities and other physical activities in the Club premises involves certain risks, including, without limitation, death, serious neck and spinal injuries resulting in complete or partial paralysis, heart attacks, and injury to bones, joints, or muscles. Participant confirms that Participant is voluntarily participating in Club programs and activities and other physical activities in the Club with knowledge of the dangers involved. In consideration of making facilities and/or services available, Participant hereby for and on behalf of Participant and Participant’s heirs and legal representatives, releases Sport & Health Holdings, L.C. and its principals, contractors, affiliates, employees, equity holders, directors, managers, members, officers, agents, representatives, guests and invitees from any and all claims and demands of every kind, nature and character which Participant may have or hereafter acquire for any and all damages, injuries or losses which may be suffered or sustained by Participant in connection with any Club program or activity. Signature _____________________________________________________________________ If Participant is under the age of 18, please complete: Age__________ Grade__________ Emergency Contact if parents cannot be reached: Name __________________________________________________ Phone Number ________________________________________ Relation to Child _________________________________________ Mother’s Name __________________________________________ Father’s Name ________________________________________ Work Phone ____________________________________________ Work Phone __________________________________________ Cell Phone ______________________________________________ Cell Phone ____________________________________________ Allergies or Medical needs _______________________________________________________________________________________ _____________________________________________________________________________________________________________ List names approved to sign out your child: 1. _____________________________________________________ Relation to Child _______________________________________ 2. _____________________________________________________ Relation to Child _______________________________________ sportandhealth.com
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