Group Swim Lesson Payments Parent Name (please use the same name that was used during registration) First Last Email Bonded / Military Member Swim Lesson(s) Price: $120.00 Quantity: Associate / Cuda Member Swim Lesson(s) Price: $130.00 Quantity: Non-Member Swim Lesson(s) Price: $140.00 Quantity: Subtotal $0.00 Online Processing Fee2.9% + $0.30 per transaction Price: $0.00 Total Payment Type Credit Card Check Check NumberPlease subtract Online Processing Fee, Mailing Address: P.O. Box 85, Simpsonville MD 21150Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Refund Policy(Required) I agree to the refund policy.Refunds will not be offered for missed days during group classes once a registration is confirmed and paid in full except in the event of a documented medical condition. All requests referencing medical issues must have accompanying documentation. Refunds initiated by ASC will be for the amount paid for the lesson(s), online fees will not be refunded.Waiver and Release of Liability(Required) I agree to the Waiver and Release of Liabilty.As parent or legal guardian, I request voluntary participation for my minor child(ren) to participate all events, which are hereinafter referred to as the “Activities,” sponsored by the Atholton Swim Club. I consent to my child(ren)’s participation in the Activities and acknowledge that I fully understand my child(ren)’s participation may involve risk of serious injury or death, including losses which may result not only from my child(ren)’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity coordinators and event staff, before I sign this document and before any Activities begins. In consideration of allowing my child(ren) to participate in the Activities, I hereby release and hold harmless Atholton Swim Club, members of its board of directors, officers, employees, volunteers, other participants, and agents (collectively, the “Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that I may have or sustain with respect to any and all damage and/or injury, of any type, arising from my child(ren)’s participation in the Activities. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. I certify that my child(ren) is in good health and has no physical condition that would prevent participation in the Activities. Furthermore, I agree to use my child(ren)’s personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required. The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages and liabilities for indemnities, contribution or otherwise with respect to any damage and/or injury, of any type, arising from my child(ren)’s participation in the Activities. The undersigned also agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Releasee and is intended to be as broad and inclusive as is permitted by the laws of the State of Maryland and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.