YMCA Summer Swim Program 301 S. Bandini, San Pedro www.ymcala.org/spp (310) 832-4211 Come to 2012 Summer Swim at the San Pedro YMCA! The YMCA has organized an exciting season of summer fun and instruction for San Pedro & Palos Verdes Families. Classes, free swim and family fun nights will be held at the San Pedro YMCA this. Beginning June 18 Sept 8, participants can enjoy 12 weeks of lessons with classes from beginning through advanced, recreational swimming, lap swimming and fun family events. A summer special rate for families in this program has been created. 10-Week Family Summer Membership - $180 (includes swim time, use of YMCA exercise facilities, youth enrichment classes and privileges for camp Whittle registration and Jr. Lakers basketball program) A family membership is valid for up to two adults and all children under the age of 18 who reside within the same household. Nanny - If you employ a nanny who will be accompanying your kids to the swim program, the nanny must be on your family membership. Swim Lesson Registration: (Summer family membership is required) Registration begins May 21, 2012. Session I: June 18 July 14 Session II: July 16 August 11 Session III: August 13 September 8 *See Swim Lesson Registration Form for a detailed list of times and class offerings. Refunds are not available after June 24, 2012. Class will not meet Wed. 7/4 or Mon. 9/3 facility will be closed. Weekday Swim Lessons - $25 per session. Each class will meet 4 weeks, once per week, for 40 minutes each. Ex. If you sign up for Monday at 1:15, you will come each Monday at 1:15 for 4 weeks. Cost is $25 for 4 classes. Sign up for as many classes as you d like! There are no makeup lessons for missed classes. Private Lessons Available: (Summer program membership is required) Private Swim lessons - $115 per week. Each class will meet 4 times per week for 20 minutes each. Lessons will be held Monday Thursday for 1 week. Private Lessons are held at the YMCA. All Private swim lesson times are dependent upon instructor availability. There are no makeup lessons for missed classes. How to Enroll 1. Send liability waiver, membership enrollment form, swim lesson registration form (if registering for swim lessons or classes) and check to the YMCA, 301 S. Bandini, San Pedro 90731, or walk forms in to YMCA. 2. A confirmation receipt will be emailed to you. If you have any questions please contact us at 310-832-4211
YMCA OF METROPOLITAN LOS ANGELES RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT IN CONSIDERATION for being permitted to utilize the facilities, services, and programs of the YMCA (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin (hereinafter referred to as the undersigned ) hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities and/or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY ON-SITE OR OFF- SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: 1. THE UNDERSIGNED, ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, volunteers and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all personal representatives, assigns, heirs, and next of kin of the undersigned for any loss or damage, and any claim or demands on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence, active or passive, of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA. 2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees, and each of them, from any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA. 3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to negligence, active or passive, of releasees or otherwise while in, about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made. THIS AGREEMENT DOES NOT APPLY TO LICENSED CHILD CARE SERVICES. I HAVE READ THIS RELEASE Date: Printed Name Signature of Applicant/Guardian Name(s) of Child(ren) in Program and/or YMCA Facility Revised 5/22/08
Staff Use Only Account Number: Date: Staff Initials: YMCA OF METROPOLITIAN LOS ANGELES Application for Membership The YMCA is a membership organization open to all. Everyone is welcome to apply regardless of race, religion, age, gender, sexual orientation, national origin, economic level or disability. If you can t afford the full cost of membership, financial assistance is available to the extent possible. Please ask for a confidential scholarship application. Participants needing other accommodation should contact their local YMCA. To provide an atmosphere that is safe and inclusive to all, the YMCA enforces a Code of Conduct. Membership is provided at the discretion of the Board of Directors and may be revoked. MEMBERSHIP TYPE Choose Membership Type: Facility CHOICE Other Choose Membership Category: Youth Adult Family Teen Other PRIMARY MEMBER (Parent or guardian for applicants under 18 years) Check ID Legal First Name M Legal Last Nameast Preferred Name Date of Birth Gender Ethnicity Home Address Apt City State Zip Code Marital Status Home Phone Cell/Other Phone Primary Emailer Employer Name How did you hear about the YMCA? What is the primary language spoken at home? GENERAL INFORMATION Emergency Contact Name (Outside of household)r Relation to Primary Member Phone Number Have you been a YMCA Member before? Yes No Are you interested in Volunteering? Yes No SECONDARY ADULT Check ID Legal First Name M Legal Last Name Preferred Name Date of Birth Gender Ethnicity Marital Status Cell/Other Phone Primary Email Employer Name Relation to Primary Member ADDITIONAL MEMBERS AND APPLICANTS Legal First Name MI Legal Last Name Preferred Name Date of Birth Gender Ethnicity
DEMOGRAPHIC INFORMATION The YMCA strives to serve the needs of our individual communities. The information gathered from the questions below helps us ensure our membership represents the communities in which we are located. 1. What is your primary reason for joining the YMCA? To improve personal or family health To participate in a specific program or activity Family Recreation and activities Youth Programs Teen Programs Other: 2. If you plan to participate in YMCA health and wellbeing programs, please check the statement that best describes your current level of exercise Primary Member: I m good at making everyday choices to be healthy and live well I try to make everyday choices to be healthy and live well, but struggle to do so Going to the Y is my first attempt to be healthy and live well Other: Unknown Second Adult: I m good at making everyday choices to be healthy and live well I try to make everyday choices to be healthy and live well, but struggle to do so Going to the Y is my first attempt to be healthy and live well Other: Unknown 3. What are the primary interests of your household? Please check all that apply. Aerobics/Group Exercise Child Care Volunteerism Group Cycling Coaching Fundraising Strength Training Parent-Child Programs Board Member Sports Senior Programs Aquatics Summer Camp Social Activities Other Resident Camp Family Recreation 4. Would you like to volunteer for the YMCA? Please specify your area(s) of interest. Aerobics/Group Exercise Child Care Volunteerism Group Cycling Coaching Fundraising Strength Training Parent-Child Programs Board Member Sports Senior Programs Aquatics Summer Camp Social Activities Other Resident Camp Family Recreation 5. Please check the box that represents your approximate annual household income: Below $15,000 $15,000-$25,500 $25,001-$38,250 $38,251-$59,999 $60,000-$99,999 $100,000+
CONDITIONS OF MEMBERSHIP Member Health: The applicant(s) represents that he/she is in physically sound condition and understands that participation in aerobics and other exercise, weight training, recreational sports, and use of pools, spas, saunas, steam rooms and fitness equipment carry a potential risk of injuries or illness. The applicant further understands that the YMCA of Metropolitan Los Angeles assumes no responsibility for any such injury or illness. Member conduct and right to use the facility: All applicants and dependents agree to abide by all policies and procedures of the YMCA of Metropolitan Los Angeles and its branches and understand that failure to act in accordance with these rules may result in expulsion from the YMCA and revocation of the membership. Criminal History: The applicant acknowledges that it is the policy of the YMCA of Metropolitan Los Angeles to deny membership to any individual convicted of a sexual offense and that the YMCA will periodically check its membership records for criminal history. Property Loss: The applicant understands that the YMCA of Metropolitan Los Angeles is not responsible for personal property lost, damaged or stolen while using YMCA facilities or participating in YMCA programs. Cell Phone/ Video Taping: Due to the advances in video equipment and telephone video technology, and for the safety and security of our members and guests, any and all video equipment may not be used in locker rooms, dressing areas, shower areas, restrooms, or other areas generally deemed to be private within YMCA facilities. The YMCA of Metropolitan Los Angeles requests that cell phone usage be reserved for lobby or designated cell phone areas only. Insurance: The applicant understands that the YMCA of Metropolitan Los Angeles does not provide any accident or health insurance for its members or participants and further understands it is the applicant s responsibility to provide such coverage. Other Conditions of Membership may apply, please see branch membership handbook or visit the Welcome Center for more information. Signature of Applicant or Guardian Date Additional Adult Applicant Date
Session II YMCA 2012 Summer Swim Registration Form - To register: mail, email, or walk in! 301 S. Bandini Street, San Pedro, CA 90731 / (310) 832-4211 / or scan to sanpedropeninsula@ymcala.org Swim Lessons are available to families with a 2012 YMCA Summer Membership OFFICE USE ONLY Fee $. Member. Staff. Step 1: Complete Summer Family Membership Registration Form Step 2: Complete Swim Class Registration Form Step 3: Sign Liability Waiver Form Parent's Name: Street Address: City and Zip Code: Email Address: Home Phone: Cell Phone: Mark an "x" to indicate Session II: July 16 - August 11 (each class meets once per week for 4 weeks.) the day/time for each Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 Fee: $25 enrollment. 1:15 PM 2:00 PM 3:30 PM 4:15 PM 5:00 PM 6:30 PM 7:15 PM 9:30a 10:15a 11:00a 11:45a Level* M T W Th M T W Th M T W Th M T W Th M T W Th M T W Th M T W Th Sat Sat Sat Sat Parent/Tot (6 to 36 mos.) Pike (3-5 yrs.) Eel (3-5 yrs.) Ray (3-5 yrs.) Starfish (3-5 yrs.) Polliwog (6-12 yrs.) Guppy (6-12 yrs.) Minnow (6-12 yrs.) Fish (6-12 yrs.) Flying Fish (6-12 yrs.) Shark (6-12 yrs.) *For correct level placement please see class description sheet. Classes may be subject to cancellation based on enrollment. Please enroll child(ren) in the following classes**: Child / Age Level* Day Time Price Special Program: Sally Smith / age 4 Eel Th 2:00 $25 Jr. Guard Prep Fee: $55 F/M, $125 P/M Lots of recreation swim available! See membership desk for a pool schedule. Private Lessons one-to-one instruction M-Th, Fee: $115 wk of 12:55 2:40 3:00 class meets for 4 weeks M & W, 4:15-5:40PM 7/16 7/23 7/30 8/6 Total $ **Please be on time - no make-ups for missed time Please make checks payable to San Pedro & Peninsula YMCA, or Credit Card Number: Exp: Subtotal of all classes fees for all enrollees $ Family Membership (Jun 18 - Sept 8, 2012) $ 180 TOTAL DUE $
SWIM CLASS LEVEL DESCRIPTIONS PARENT TOT AGES 6 TO 36 MONTHS W/PARENT IN WATER Class focuses on water adjustment and building a foundation for future water instruction through singing songs and using flotation devices. A swim diaper is required for all children. PIKE: PRESCHOOL BEGINNER Class designed for the preschooler with little or no prior swim lesson experience - helps the child get comfortable with putting their face in the water, blowing bubbles, jumping in, going under and swimming out to an Instructor. EEL: PRESCHOOL INTERMEDIATE Class designed for the preschooler who is comfortable putting their head in the water, jumping in and going under water, and who can swim 3 to 5 feet unassisted. The focus is on learning to breathe and swim unassisted 15 to 20 feet. RAY: PRESCHOOL ADVANCED Class designed for the preschooler who has learned how to breath and can swim 15 to 20 feet unassisted. Participants in this level work towards swimming 25 yards unassisted. STARFISH: PRESCHOOL ADVANCED Class designed for the preschooler who has learned how to swim the length of the lap pool but is not yet 6 years old. Participants in this level will work on stroke refinement and endurance as well as aquatic games! POLLIWOG: SCHOOL AGE BEGINNER A beginning level designed for the school age child with little or no prior swim lesson experience. Class focus is on water adjustment, basic swimming skills and water safety. MINNOW: SCHOOL AGE INTERMEDIATE CLASS Level is designed to perfect the front and back crawl and begin to refine the breast and elementary back stroke. FISH: SCHOOL AGE INTERMEDIATE CLASS Level is designed to perfect breast and elementary back stroke and introduce the butterfly and side strokes. FLYING FISH: SCHOOL AGE ADVANCED CLASS Level is designed to work on endurance and racing strokes. Endurance and stroke refinement will be focused on. SHARK: SCHOOL AGE ADVANCED CLASS This advanced level is continues the focus on endurance and stroke refinement introduces the flip turns and refinement of racing strokes. Lifeguarding strokes are also introduced. BEGINNER ADULT CLASS This class is geared towards the beginning swimmer, ages 13 years and up, who is looking for increased water safety and confidence. Basic stroke technique and floating will be worked on. INTERMEDIATE ADULT CLASS This class is geared to the adult, ages 13 years and up, who can swim but is looking for increased endurance and stroke efficiency. Individuals signing up for this class should be comfortable in deep water. JR. GUARD PREP This class teaches youths 10-K basic water safety and lifeguarding skills. Participants will learn about the importance of physical fitness and will gain physical endurance. This class prepares students to pass the Jr. Lifeguard Beach Test. (land & water workouts). GUPPY: SCHOOL AGE BEGINNER Participants must be able to swim 15 to 20 feet unassisted. Class focuses on stroke techniques and breathing.