Box Elder Natatorium
             
 
 

Summer Session 2 - (June 18-28) - Monday - Thursday for 2 Weeks

Session 2 Participant(s):   $35.00   Quantity:   Item Subtotal:  
$0.00
Lesson Time [1]
Participants Full Name (First | Last) [1]
Participant's Age [1]
Level [1]

Lesson Time

[2]
Participants Full Name (First | Last) [2]
Participant's Age [2]
Level [2]

Lesson Time

[3]
Participants Full Name (First | Last) [3]
Participant's Age [3]
Level [3]

Lesson Time

[4]
Participants Full Name (First | Last) [4]
Participant's Age [4]
Level [4]

Lesson Time

[5]
Participants Full Name (First | Last) [5]
Participant's Age [5]
Level [5]

Lesson Time

[6]
Participants Full Name (First | Last) [6]
Participant's Age [6]
Level [6]

Lesson Time

[7]
Participants Full Name (First | Last) [7]
Participant's Age [7]
Level [7]

Lesson Time

[8]
Participants Full Name (First | Last) [8]
Participant's Age [8]
Level [8]

Lesson Time

[9]
Participants Full Name (First | Last) [9]
Participant's Age [9]
Level [9]

Lesson Time

[10]
Participants Full Name (First | Last) [10]
Participant's Age [10]
Level [10]
 

Summer Session 3 - (July 9-19) - Monday - Thursday for 2 Weeks

Session 3 Participant(s):   $35.00   Quantity:   Item Subtotal:  
$0.00
Session 3 - Lesson Time [1]
Participants Full Name (First | Last) [1]
Participant's Age [1]
Level [1]

Session 3 - Lesson Time

[2]
Participants Full Name (First | Last) [2]
Participant's Age [2]
Level [2]

Session 3 - Lesson Time

[3]
Participants Full Name (First | Last) [3]
Participant's Age [3]
Level [3]

Session 3 - Lesson Time

[4]
Participants Full Name (First | Last) [4]
Participant's Age [4]
Level [4]

Session 3 - Lesson Time

[5]
Participants Full Name (First | Last) [5]
Participant's Age [5]
Level [5]

Session 3 - Lesson Time

[6]
Participants Full Name (First | Last) [6]
Participant's Age [6]
Level [6]

Session 3 - Lesson Time

[7]
Participants Full Name (First | Last) [7]
Participant's Age [7]
Level [7]

Session 3 - Lesson Time

[8]
Participants Full Name (First | Last) [8]
Participant's Age [8]
Level [8]

Session 3 - Lesson Time

[9]
Participants Full Name (First | Last) [9]
Participant's Age [9]
Level [9]

Session 3 - Lesson Time

[10]
Participants Full Name (First | Last) [10]
Participant's Age [10]
Level [10]
 

Summer Session 4 - (July 30 - August 9) - Monday - Thursday for 2 Weeks

Session 4 Participant(s):   $35.00   Quantity:   Item Subtotal:  
$0.00
Session 4 - Lesson Time [1]
Participant's Full Name (First / Last) [1]
Participant's Age [1]
Level [1]

Session 4 - Lesson Time

[2]
Participant's Full Name (First / Last) [2]
Participant's Age [2]
Level [2]

Session 4 - Lesson Time

[3]
Participant's Full Name (First / Last) [3]
Participant's Age [3]
Level [3]

Session 4 - Lesson Time

[4]
Participant's Full Name (First / Last) [4]
Participant's Age [4]
Level [4]

Session 4 - Lesson Time

[5]
Participant's Full Name (First / Last) [5]
Participant's Age [5]
Level [5]

Session 4 - Lesson Time

[6]
Participant's Full Name (First / Last) [6]
Participant's Age [6]
Level [6]

Session 4 - Lesson Time

[7]
Participant's Full Name (First / Last) [7]
Participant's Age [7]
Level [7]

Session 4 - Lesson Time

[8]
Participant's Full Name (First / Last) [8]
Participant's Age [8]
Level [8]

Session 4 - Lesson Time

[9]
Participant's Full Name (First / Last) [9]
Participant's Age [9]
Level [9]

Session 4 - Lesson Time

[10]
Participant's Full Name (First / Last) [10]
Participant's Age [10]
Level [10]
Payment Information
Method of Payment:
Convenience Fees: Credit cards: 3% plus $0.25 ($1.50 min)
                    (+1.5% convenience for foreign cards)
Update name from
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from
Cardholder's Name:
Billing ZIP/Postal Code:
Total:
$0.00
 
Parent/Guardian Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Emergency Contact
Emergency Contact Phone

Agreement and Release from Liability

 Except for damages arising out of willful negligence of the Box Elder Natatorium, I hereby agree to indemnify and hold harmless the Box Elder Natatorium, its officers, directors and employees, and Box Elder School District from and against any and all liability or injuries which I or my child may suffer arising out of or in any way connected with my or my childs participation in this program. In case of emergency, arising during or in connection with any activity, I authorize any person in charge of the activity to consent to emergency transportation, medical treatment for me or my child, at my expense.  I agree to pay for any damages or expenses incurred by the Box Elder Natatorium due to my or my childs negligence or disregard of the rules of the program.

  *Please note that there are no refunds.  Parents of swim students are requested to observe swim lessons from the balcony.  Parents are not allowed on the pool deck.

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE BOX ELDER NATATORIUM AND I SIGN IT OF MY FREE WILL.

I Agree
Please read the verbiage above

Please be aware that payments will reflect on your statement as

B.E.S.D 800-764-0844 Brigham City UT
 
Use Instant Payments to accept payments for your business.
SIP Program & Data © 2006-2018 Instant Payments All rights reserved.
~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~
SIP master Version 2.17; API: 2.4
Get Help RSI Security Instant Payments, Payment Processing Service, Clinton, UT