Please ONLY register if you are ready to be put onto the schedule, pay your registration fees and have had all your questions answered. If you would like to know when we have availability, have questions or would like to know more, please call or email using the information at the top of the website.

  • Parent's Information
  • Children's Information
  • Agreement Forms
  • Signature/Registraion

Parent's Information

First Name

Last Name

Phone Number

Email Address

Children's Information

Child information is mandatory. There will be a delay in the registration process if your child’s information is not filled out accurately. If you have more than one child to register please scroll down to where it says, Child 2 and scroll down each time for as many children as you wish to register.

Child's Name

Birthdate in MM-DD-YY Format

Previous swim experience with Ms. Emma

Has your child seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? * Please include any allergies, medications, surgeries, therapies, hospitalization etc...

Do you have additional children to add?

Child #2

Child's Name

Birthdate in MM-DD-YY Format

Previous swim experience with Ms. Emma

Has your child seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? * Please include any allergies, medications, surgeries, therapies, hospitalization etc...

Child #3

Child's Name

Birthdate in MM-DD-YY Format

Previous swim experience with Ms. Emma

Has your child seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? * Please include any allergies, medications, surgeries, therapies, hospitalization etc...

Child #4

Child's Name

Birthdate in MM-DD-YY Format

Previous swim experience with Ms. Emma

Has your child seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? * Please include any allergies, medications, surgeries, therapies, hospitalization etc...

Photo/Video Release

I give permission to Ms. Emma's Swim and Survival Academy and its instructors to photograph and record and to utilize photographs or other likenesses of me and/or my minor child(ren) on videotape, audiotape, photograph or any other medium in all forms of advertising, trade and any other lawful purposes including but not limited to: print advertising, photographs, video, website, and social media. I further consent to the use of my name, voice and/or biographical data in connection with such use.

Release of Liability

I release and hold harmless Ms. Emma's Swim and Survival Academy its owners, operators and instructors from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participants and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Ms. Emma's Swim and Survival Academy, its owners, operators, pool hosts, or in route to or from any of said premises. I also acknowledge that enrollment, participation in or completion of lessons in no way implies that the participants are drown proof or water safe and that as the parent or legal guardian of the participants, I am ultimately responsible for my child's safety in or around water and must at all times ensure appropriate, vigilant and persistent supervision.*

Assumption of Risk

I understand, agree and acknowledge that there are risks inherent in sports activities conducted by Ms. Emma's Swim and Survival Academy and its instructors. These activities may be of a hazardous nature and/or may include swimming, diving and a variety of strenuous exercise and physical activities. With the full understanding of the facts, I state that to the best of my knowledge, the participants I am registering have no medical, physical, or emotional conditions that would hinder or prevent safe participation in Ms. Emma's Swim and Survival Academy programs.*

Enrollment Review and Payment Policies

I understand that I am enrolling for swim lessons with Ms. Emma's Swim and Survival Academy and that the information submitted on this enrollment form will require review as it is the intent of Ms. Emma's Swim and Survival Academy to provide each participant with an individualized, effective and safe learning experience. I acknowledge that in some health-related cases, Ms. Emma's Swim and Survival Academy may not be able to provide services. I certify that all medical/health information I have provided is correct and true and agree to provide additional information, including a physician's clearance if requested, prior to the beginning of any lessons. I understand that in order to secure my child(ren)'s selected lesson time(s) I must pay all applicable registration fees per the instructions sent to me. I understand that participant enrollment may be canceled if payment is not received.*

Parent Digital Signature

Cost of Registration is $65 for 1st year. $30 for 2nd year and free from 3rd year and onwards.

Parent Digital Signature

Upon submitting your registration you will receive an email with your registration information. **PLEASE CHECK YOUR JUNK/SPAM FOLDER. Within 48 hours, you will be contacted, via email, with instructions to pay your non-refundable Registration Fee (if applicable). If you are not contacted via email please call Ms.Emma at 813-748-6142. Upon receipt of your registration fee, (if applicable) you will receive a link to access the schedule.

I have read and understand the terms and conditions of the above statement.