A Second Breath Swimming Lesson Registration 2023
Please Complete this form and submit. A separate form needs to be completed for each registered swimmer.

The registration and waiver form must be completed and returned with payment by either mail, email or in person at the time of registration. Once both the registration form and payment are received your registration will be processed based on availability. Payment can be made in cash, by cheque or etransfer.

If you have any questions please call or text Beckie 519-282-5382 or email at info@asecondbreath.ca 
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Email *
Swimmer's First and Last Name *
Level Swimmer is Entering *
Date of Birth for Swimmer *
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Current Age *
Preferred Time: please in the notes add any specific details that would help with scheduling, EX. 4pm latest, after 6pm *
Please ONLY select the course option(s) you wish to REGISTER your child(ren) in.  *
Required
Course Fees, please select one
FYI 1hr classes NOT recommended for anyone in Swimmer 5 or below
*
Required
Allergies/Medical Conditions *
Parent/Guardian Contact Information: First and Last Name *
Parent Contact Information: Phone Number *
Additional Details/Comments (scheduling, child's needs etc.)
Proposed Method of Payment *
Waiver: Welcome to “A Second Breath Swim School”. We are excited to offer our swimming facility to you and your family. We have designed our swimming facility to cater to all ages with a large step entry, three variable depths and dimensions that allow for all needs. Whatever the weather throws at us during the instructional day, we will be ready with our heated, salt water pool. A salt water pool is gentle on the skin and wonderful for all who enjoy opening their eyes under the water. Each of our highly qualified instructors demonstrates their love for teaching through their handling of each child in the pool. For many of you who do know us, we would like to say “Welcome Back!” for yet another exciting summer of swimming lessons. We do have some regulations in place that we would like to pass on to you, as parents. While your child or children are learning to swim with us, we kindly ask you to follow these guidelines:Relax and enjoy the summer weather in the designated sitting area found outside the fenced area and please refrain from leaning/standing on the fence. Your children are in good hands; allow us to instruct your child or children while in class. We do not mind you watching your child’s lesson but would ask you remain outside the fence in the designated area. Our property is close to our neighbors and we want to respect their property and privacy as well. Our home, decks, flowers beds, play equipment and trampoline etc. are off limits at all times. Please remind your children of this.If you have children with you waiting, there is a playground across the road. With your supervision, they can also enjoy the summer weather playing on the swings and slides. We do offer a washroom on site for our swimmers to use if needed. Inclement weather is one thing we cannot control. Heavy rain, thunder and/or lightning will result in lessons being cancelled. Please use your discretion and if in doubt call or text 519‐282‐5382. Lessons cancelled due to acts of nature will not be rescheduled. If your child is unable to attend a class please advise the instructor in advance of the absence. Unfortunately our schedule does not allow for make‐up classes. Agreement Terms: I understand that this is a physical activity program and to the best of my knowledge my child is physically able to participate in all parts of the program. I do not hold A Second Breath Swim School or its staff responsible for any injury, loss or damage sustained by my child or his or her property as a result of their participation in this program. I give permission to A Second Breath Swim School staff to administer any emergency medical care needed during my child’s participation in the program. Yes, I agree to give permission for the individual registered in A Second Breath Swim School to participate in the program. Registration forms and waiver form must be completed and returned with payment by either mail, email or in person at the time of registration. Once all of these forms are completed your registration will be processed based on availability. Payment can be made in cash or cheque ,or etransfer payable to A Second Breath. Registrar: A Second Breath, 34701 Creamery Rd Ailsa Craig, ON, N0M 1A0, 519.282.5382 Info@ASecondBreath.ca *
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