here. - Vera Aquatics

&
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 _______________________________________
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