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Blue Water Divers

Swim School

Phone (201)843-3340

201 Route 17 South, Rochelle Park

Swim Registration Form

This form only holds information and can not charge your card or sign you up. BWD will be in-contact with you to submit payment and select a class.


Please check "I agree" in each box

Well-fitting goggles are an essential part of the students' swimming experience. Our staff can custom fit you with high quality, well-fitting goggles that carry an in-water fit guarantee. In-water fit guarantee:goggles can be swapped out until the appropriate size and fit has been selected and the difference in price has been settled.

I Agree

Please note we charge a flat rate of $100.00 per month, regardless if there are 3, 4 or 5 lessons in the month that the swimmer is signed into. ( Due to public holidays.) 

I Agree

Swim caps are mandatory for anyone with hair below their ears.

I Agree

Any child that is not toilet trained is required to wear a swim diaper and plastic pants underneath their swim suit.

I Agree

Refund policy: If after the first lesson you feel this level is inappropriate for you or your child, you can apply the balance towards another level. There are no refunds. Registration fees are non-refundable and non-transferable.

I Agree

Make-up Policy: In order to maintain the integrity of our classes both as to content and to size, we do not offer make-up classes. Please do your best to attend. Cancellation/No Show Policy will result in a forfeit of class lesson.

I Agree

We are closed for Public Holidays. These include but are not limited to New Years, Memorial Day weekend, Mother's Day, Father's Day, Labor Day weekend,Independence Day, Thanksgiving andChristmas..

I Agree

Supervision of your child is required at all times. For safety reasons, students are not allowed to enter the pool before class, and are not permitted to stay in the pool after the instructor has dismissed class.We recommend drying off your child in the pool area before leaving the area.

I Agree

Siblings are not permitted to swim in the pool during, before or after any swim lesson. Only swimmers enrolled in our program are allowed to be in the pool during their appropriate swim time.

I Agree

All business transactions must be done through the BWD Rochelle Park location. No checks or cash will be collected at the swimming pool.

I Agree

A minimum of a two months sign-up is required, thereafter billing will occur on a month-to-month basis, on the first business day of the month. If you wish to discontinue lessons; please submit a cancellation notice or any other written notice 30 days prior to the start of the next month.

I Agree

We would appreciate 24 hours notice for a cancellation to inform the instructor of your child's absence.

I Agree

All new customers are obligated to purchase a one-time family membership fee of $45.00

I Agree

The deck of the pool will get slippery at times; flip-flops are recommended.

I Agree

In the event of bad weather, we will do our best to contact you. If you have any doubt, please call BWD at 201-843-3340, or visit www.bwdswimschool.com or Facebook BWD Swim school for cancellations.

I Agree

Returned check fee: $25

I Agree

I have read and understand the above information.

I, the enrolled participant and/or the parent/guardian of the participant (if the participant is under 18 years of age), agree and understand that swimming is a HAZARDOUS activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to, paralyzing injuries and death.

I hereby authorize any representative of Blue Water Divers Swim School to have the above, named(minor) student treated in any medical emergency during their participation in any Blue Water Divers Swim School Program. Futher, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

In addition, we agree not to hold Blue Water Divers Swim School, Saddle Brook Inn and Courtyard Marriot, its team members, instructors and employees responsible for any accident or other such occurrence.

I also grant permission to Blue Water Divers Swim School to use my child's and/or my photograph on its website or in any other official BWD printed publication without further consideration.

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.

April 24, 2024

First Swim Students Name

First Name*

Last Name*

Phone*
First Swim Students Date of Birth*
First Swim Students Signature*
Second Swim Students Name

First Name*

Last Name*

Phone*
Second Swim Students Date of Birth*
Third Swim Students Name

First Name*

Last Name*

Phone*
Third Swim Students Date of Birth*
Fourth Swim Students Name

First Name*

Last Name*

Phone*
Fourth Swim Students Date of Birth*
Fifth Swim Students Name

First Name*

Last Name*

Phone*
Fifth Swim Students Date of Birth*
Sixth Swim Students Name

First Name*

Last Name*

Phone*
Sixth Swim Students Date of Birth*
Seventh Swim Students Name

First Name*

Last Name*

Phone*
Seventh Swim Students Date of Birth*
Eighth Swim Students Name

First Name*

Last Name*

Phone*
Eighth Swim Students Date of Birth*
Ninth Swim Students Name

First Name*

Last Name*

Phone*
Ninth Swim Students Date of Birth*
Tenth Swim Students Name

First Name*

Last Name*

Phone*
Tenth Swim Students Date of Birth*
Swim Students Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Medical Question

List any pertinent medical history, learning disabilities or allergies that we should be aware. *
Recurring Payments:
For recurring payment authorization only. Please indicate if you would like to be signed up on an automatic monthly renewal. If you select yes, please fill out all fields accurately. This form does not charge the card holder but only holds information. Please note that when you select no, customer will be responsible for signing back up for a two month period.*
Yes - Auto Monthly Renewal
No - 2 Month

Expiration date *

Account number
Card Type
VISA
MasterCard
Amex
Discover
other

Cardholder name

CVV *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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