PAYMENT DETAILS
All automatic debits will be charged on the 5th of each month for the upcoming month and tuition will be prorated up until the
first debit run. A $25 membership fee is due at time of registration and deducted every July following, although the membership
fee at the time of enrollment will be pro-rated. I authorize La Petite Baleen to deduct from my account for the monthly tuition
which may vary due to: unexpected pool closures, holidays, rejected accounts, etc. La Petite Baleen also agrees to give
30-days notice to customers in the event of a rate change. We do not offer make-ups, refunds or credits for missed
lessons. You may be assessed a $10.00 handling charge on any declined automatic debit transaction. Expect to pay these
fees in full before the next auto debit or you will be removed from our swim schedule. The fee for a returned check is $30.00.
WITHDRAWAL DETAILS
If you wish to withdraw from your lessons, a written cancellation notice is required. We prefer to have 30 days notice
but if you need to cancel immediately, a LPB credit will be applied towards your account for future lessons. No refunds.
This can be submitted online at www.swimlpb.com.
CONSENT FOR EMERGENCY MEDICAL TREATMENT
In the event of an emergency, the undersigned parent(s)/guardian(s) of the participant(s) hereby grants authorization to
La Petite Baleen Swim School and its representatives, to employ any legally licensed physician or health care facility
on behalf of the undersigned, and to direct and/or order emergency medical treatment for the participant(s). Each of
the undersigned further agrees that neither La Petite Baleen nor any of it's representatives, shall be liable under any
circumstance to anyone for exercising the forgoing authority in the event of an emergency.
INFORMED CONSENT AND WAIVER/RELEASE
I, the undersigned, as the parent(s) or legal guardian(s) of the child(ren) listed on the application in consideration of the
request and permission of my son(s)/daughter(s) to participate in La Petite Baleen's programs, including, but not limited
to swim lessons, birthday parties, and love'em and leave'em, hereby assume full responsibility for all risks of injury or loss
which may result from my son(s)/daughter(s) participation in this activity and herby agree to hold harmless, release and
forever discharge La Petite Baleen, its officers, agents and employees, from and waive any and all claims and demands
whatsoever which the undersigned and any of them or any third person of any accident, illness, injury or death of any
person and persons, or damage or loss or destruction of any property arising or resulting from swimming and/or running
indirectly from my son(s)/daughter(s) participation in the aforementioned program and occurring during said participation
or any time subsequent thereto, save and except that the above provisions shall not be applicable to injury to or death of
persons, or damage or loss of property arising out of sole negligent acts or omissions of La Petite Baleen, their officers,
agents or employees. The term of this release shall serve as a release and assumption of risk for my son(s)/daughter(s)
listed on this application has no medical, physical, mental, or emotional heath condition which would hinder or prevent his/
her active participation in La Petite Baleen's programs.
PHOTOS & VIDEOS
I understand that photos and videos may be taken during my swim class. This media may be used for staff training and/or advertising for La Petite Baleen. I may notify my teacher if I wish to exclude my child(ren) from any photos or video.
AUTHORIZATION
I have read and accept the general and financial policies. I understand that by signing this authorization, I am entering into
an agreement with La Petite Baleen Swim Schools.
