{"id":44068,"date":"2023-01-03T15:27:13","date_gmt":"2023-01-03T20:27:13","guid":{"rendered":"https:\/\/berkshiresouth.org\/formularios-adaptiveaquatics\/"},"modified":"2026-02-24T11:07:47","modified_gmt":"2026-02-24T16:07:47","slug":"forms-adaptiveaquatics","status":"publish","type":"page","link":"https:\/\/berkshiresouth.org\/es\/forms-adaptiveaquatics\/","title":{"rendered":"formularios-adaptiveaquatics"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"44068\" class=\"elementor elementor-44068 elementor-19311\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-33a79095 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"33a79095\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3706530d\" data-id=\"3706530d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-537de1f elementor-widget elementor-widget-heading\" data-id=\"537de1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Inscripci\u00f3n Acu\u00e1tica Adaptativa<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2dbed9a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2dbed9a\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1ca627b\" data-id=\"1ca627b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-42fd904 elementor-widget elementor-widget-heading\" data-id=\"42fd904\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u00a1inscr\u00edbete hoy en tu programa de Acu\u00e1tica Adaptada!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d55da67 elementor-widget elementor-widget-heading\" data-id=\"d55da67\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">|un formulario por participante<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-432499d elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"432499d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-150af7f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"150af7f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9cfb98f\" data-id=\"9cfb98f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-523901b elementor-widget elementor-widget-shortcode\" data-id=\"523901b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-19310 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-19310\" data-uid=\"69ea6ba2a0c68\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-19310\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-19310 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"19310\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69ea6ba2a0c68\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Personal Data<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69ea6ba2a0c68-label\"><span id=\"forminator-radiogroup-radio-1-69ea6ba2a0c68-label\" class=\"forminator-label\">Membership Status <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69ea6ba2a0c68\" class=\"forminator-radio forminator-radio-inline\" title=\"Member\"><input type=\"radio\" name=\"radio-1\" value=\"Member\" id=\"forminator-field-radio-1-1-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Member<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69ea6ba2a0c68\" class=\"forminator-radio forminator-radio-inline\" title=\"Non Member\"><input type=\"radio\" name=\"radio-1\" value=\"Non-Member\" id=\"forminator-field-radio-1-2-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non Member<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69ea6ba2a0c68\" id=\"forminator-field-name-1_69ea6ba2a0c68-label\" class=\"forminator-label\">Participant&#039;s First Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"First name\" id=\"forminator-field-name-1_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-5\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-5_69ea6ba2a0c68\" id=\"forminator-field-name-5_69ea6ba2a0c68-label\" class=\"forminator-label\">Participant&#039;s Last Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"Last name\" id=\"forminator-field-name-5_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69ea6ba2a0c68\" id=\"forminator-field-name-2_69ea6ba2a0c68-label\" class=\"forminator-label\">Parent\/Guardian First Name (if applicable)<\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"First name\" id=\"forminator-field-name-2_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-6\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_69ea6ba2a0c68\" id=\"forminator-field-name-6_69ea6ba2a0c68-label\" class=\"forminator-label\">Parent\/Guardian Last Name (if applicable)<\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"Last name\" id=\"forminator-field-name-6_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69ea6ba2a0c68\" id=\"forminator-field-text-1_69ea6ba2a0c68-label\" class=\"forminator-label\">Participant&#039;s Date of Birth <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"MM\/DD\/YYYY\" id=\"forminator-field-text-1_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69ea6ba2a0c68\" id=\"forminator-field-email-1_69ea6ba2a0c68-label\" class=\"forminator-label\">Email\/Parent or Guardian Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69ea6ba2a0c68\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69ea6ba2a0c68\" id=\"forminator-field-address-1-street_address_69ea6ba2a0c68-label\" class=\"forminator-label\">Street Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_69ea6ba2a0c68\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" aria-describedby=\"forminator-field-address-1-street_address_69ea6ba2a0c68-description\" \/><span id=\"forminator-field-address-1-street_address_69ea6ba2a0c68-description\" class=\"forminator-description\">Please add the address for the participant<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_69ea6ba2a0c68\" id=\"forminator-field-address-1-address_line_69ea6ba2a0c68-label\" class=\"forminator-label\">Apartment, suite, etc<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_69ea6ba2a0c68\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69ea6ba2a0c68\" id=\"forminator-field-address-1-city_69ea6ba2a0c68-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"\" id=\"forminator-field-address-1-city_69ea6ba2a0c68\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_69ea6ba2a0c68\" id=\"forminator-field-address-1-state_69ea6ba2a0c68-label\" class=\"forminator-label\">State\/Province <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"\" id=\"forminator-field-address-1-state_69ea6ba2a0c68\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69ea6ba2a0c68\" id=\"forminator-field-address-1-zip_69ea6ba2a0c68-label\" class=\"forminator-label\">ZIP \/ Postal Code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"\" id=\"forminator-field-address-1-zip_69ea6ba2a0c68\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69ea6ba2a0c68\" id=\"forminator-field-phone-1_69ea6ba2a0c68-label\" class=\"forminator-label\">Home Phone<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"123 456 7890\" id=\"forminator-field-phone-1_69ea6ba2a0c68\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69ea6ba2a0c68\" id=\"forminator-field-phone-2_69ea6ba2a0c68-label\" class=\"forminator-label\">Cell Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"123 456 7890\" id=\"forminator-field-phone-2_69ea6ba2a0c68\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"us\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_69ea6ba2a0c68\" id=\"forminator-field-name-3_69ea6ba2a0c68-label\" class=\"forminator-label\">Emergency Contact Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"First and last name\" id=\"forminator-field-name-3_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_69ea6ba2a0c68\" id=\"forminator-field-phone-3_69ea6ba2a0c68-label\" class=\"forminator-label\">Emergency Contact Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"123 456 7890\" id=\"forminator-field-phone-3_69ea6ba2a0c68\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"us\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Swim Lessons<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69ea6ba2a0c68-label\" aria-describedby=\"forminator-radiogroup-radio-2-69ea6ba2a0c68-description\"><span id=\"forminator-radiogroup-radio-2-69ea6ba2a0c68-label\" class=\"forminator-label\">Please select your class preference from the list below. Our instructor will confirm your class based on level of need and availability. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69ea6ba2a0c68\" class=\"forminator-radio\" title=\"Adult (18+) Adaptive Swim Lessons: Mondays, October 9th \u2013 November 13th, 4-5:30pm\"><input type=\"radio\" name=\"radio-2\" value=\"adult-18-adaptive-swim-lessons-mondays-october-9th-november-13th-4-5-30pm\" id=\"forminator-field-radio-2-1-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-69ea6ba2a0c68-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Adult (18+) Adaptive Swim Lessons: Mondays, October 9th \u2013 November 13th, 4-5:30pm<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69ea6ba2a0c68\" class=\"forminator-radio\" title=\"Youth (6+) Adaptive Swim Lessons: Tuesdays, October 10th \u2013 November 14th, 4-5:30pm\"><input type=\"radio\" name=\"radio-2\" value=\"youth-6-adaptive-swim-lessons-tuesdays-october-10th-november-14th-4-5-30pm\" id=\"forminator-field-radio-2-2-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-69ea6ba2a0c68-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Youth (6+) Adaptive Swim Lessons: Tuesdays, October 10th \u2013 November 14th, 4-5:30pm<\/span><\/label><span id=\"forminator-radiogroup-radio-2-69ea6ba2a0c68-description\" class=\"forminator-description\">One registration form per swimmer!<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-19310__field--select-3_69ea6ba2a0c68\" id=\"forminator-form-19310__field--select-3_69ea6ba2a0c68-label\" class=\"forminator-label\">How did you hear about us? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-19310__field--select-3_69ea6ba2a0c68\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-placeholder=\"Please select one\" data-search=\"false\" data-search-placeholder=\"Please select one\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-19310__field--select-3_69ea6ba2a0c68-label\"><option value=\"\"  >Please select one<\/option><option value=\"Radio\"  data-calculation=\"0\">Radio<\/option><option value=\"Print\"  data-calculation=\"0\">Print<\/option><option value=\"Flyer\"  data-calculation=\"0\">Flyer<\/option><option value=\"Friend\"  data-calculation=\"0\">Friend<\/option><option value=\"Catalog\"  data-calculation=\"0\">Catalog<\/option><option value=\"e-Newsletter\"  data-calculation=\"0\">e-Newsletter<\/option><option value=\"Social-Media\"  data-calculation=\"0\">Social Media<\/option><option value=\"Search-Engine\"  data-calculation=\"0\">Search Engine<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Terms And Conditions\/ Cancellation Policies<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_00c8d54 elementor-col-100\"><b>Release of all Claims and Promise Not to Sue: <\/b> <br \/>As a participant in a program through Berkshire South Regional Community Center(BSRCC), I recognize and acknowledge that there are certain risks and I agree to assume all such risks, including any damage resulting from physical injuries, loss of services or consortium, loss or damage to property, or any other loss I may sustain as a result of participation in any and all activities connected with or associated with such program(s). In consideration of BSRCC accepting my or my child's registration, and with the intent to be legally bound, hereby, for myself, for my child, all heirs, executors, administrators, and assigns, do hereby forever release, waive and relinquish all claims I have or may have as a result of participating in this and all other programs of BSRCC. Furthermore, I promise not to sue BSRCC and agree to indemnify and hold harmless and defend BSRCC and it's officers, agents, servants, employees and insurers from any and all liabilities, claims, demands, actions or causes of action resulting from my or my child's participation in this or any other program(s) at BSRCC.<\/div>\n<div>\u00a0<\/div>\n<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e701662 elementor-col-100\"><b>Liability Waiver<\/b> <br \/>In consideration of being allowed to use the facility, equipment, machinery and\/or programs, participant(s) personally assume all risks involved in any exercising, training, activities and\/or programs at the Center. Participant(s) recognize and acknowledge that there are certain risks of physical injury involved in undertaking any fitness activity. Participant(s) thereby voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of the severity, that they may sustain as a result of said participation. Participant(s) are solely responsible for determining if they are physically fit and\/or adequately skilled for said activity. It is always advisable to consult a physician before undertaking any fitness activity. Please be aware that by signing and\/or participating in any Berkshire South activity, participant(s) are expressly assuming the risk, the legal liability, are waiving and generally releasing all claims for injuries, damages or loss which one might sustain as a result of participating in any and all activities connected with and associated with Berkshire South. Participant(s) also waive and release, now and forever, all claims and causes of action against Berkshire South, its elected or appointed officers, agents, volunteers, employees, representatives, consultants, executors, and all others directly or indirectly connected with Berkshire South from any and all: personal injuries (including death), any medical condition of any kind which results, any aggravation of a pre-existing medical condition, and any and all other damages or injuries which may be sustained in any way from the direct or indirect result of activities, exercise, training and participation in the Center. Participant(s) further hold Berkshire South harmless from any loss to personal property which is lost, damaged or stolen at Berkshire South.<\/div>\n<div>\u00a0<\/div>\n<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9db2bc4 elementor-col-100\"><b>Participant Responsibilities <\/b> <br \/>Participant is aware that Berkshire South Regional Community Center is an intergenerational facility open to a diverse population and will act respectfully toward all other members and guests. Participant acknowledges that inappropriate actions by himself\/herself, his\/her family, or his\/her guests could result in their not being allowed to participate in programs. Further, management of the Center may suspend or cancel the rights, privileges of participants whose actions are detrimental to the enjoyment of the Center facilities by other guests, or for failure to comply with Center rules. Participant is aware that any exercise program undertaken may create physical stress resulting in harmful effects. It is solely Participant's responsibility to consult with a physician prior to commencing any exercise program, to remain under medical supervision if that is indicated and to seek medical assistance in the event of injury. Participant recognizes that the use of exercise equipment and other facilities provided by Berkshire South carries some risk of accidental injury to himself\/herself and others and agrees to use such equipment and facilities with due care.<\/div>\n<div>\u00a0<\/div>\n<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_adb158e elementor-col-100\"><b>Insufficient Funds, Arrears and Default <\/b> <br \/>All checks that are returned with insufficient funds are subject to a $25 fee.<\/div>\n<div>\u00a0<\/div>\n<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ee45878 elementor-col-100\"><b>Refund Policy <\/b> <br \/>Cancellation requests made at least 7 days prior to the first day of the program will receive a full reimbursement minus a $5 administrative fee. Please submit a cancellation request to the Front Desk at Berkshire South. NO REFUNDS WILL BE MADE AFTER THIS TIME UNLESS BSRCC CANCELS THE PROGRAM. Participants assume the risk and responsibility for changes in their personal schedules or health. Please allow up to two (2) weeks for processing refunds.<\/div>\n<div>\u00a0<\/div>\n<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0816b5f elementor-col-100\"><b>COVID-19 Waiver of Liability<\/b> <br \/>The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Berkshire South Regional Community Center (Berkshire South) has put in place preventative measures to reduce the spread of COVID-19. The Center has followed guidance from the CDC, local health agencies and public officials to update policies, practices and procedures to ensure the highest standards of cleanliness and hygiene and make appropriate accommodations for physical\/social distancing. Members and guests must come prepared to follow new cleaning procedures which may include cleaning all equipment prior to and after use. However, even with these preventative measures in place, Berkshire South cannot guarantee that members will not become infected with COVID-19. Further, entering Berkshire South could increase my risk of contracting COVID-19. By submitting this agreement, you are acknowledging the contagious nature of COVID-19 and are voluntarily assuming the risk that you may be exposed to and\/or infected by COVID-19 and that such exposure or infection may result in personal injury, illness, permanent disability, and death. By submitting, you understand that the risk of becoming exposed to and\/or infected by COVID-19 at Berkshire South may result from the actions, omissions, or negligence of yourself and others, including, but not limited to, Berkshire South employees, volunteers, and program participants and their families. By submitting, you voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to yourself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that you may experience and\/or incur in connection with attendance at Berkshire South. You hereby release, covenant not to sue, discharge, and hold harmless Berkshire South Regional Community Center employees, agents, and representatives, of and from Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. You understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Center, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after attendance at Berkshire South Regional Community Center.<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69ea6ba2a0c68-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-69ea6ba2a0c68-label\" class=\"forminator-label\">Photo Release <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-69ea6ba2a0c68-label\" for=\"forminator-field-checkbox-1-1-69ea6ba2a0c68\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Yes\" id=\"forminator-field-checkbox-1-1-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-checkbox-1-1-69ea6ba2a0c68-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-1-69ea6ba2a0c68-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69ea6ba2a0c68-label\" for=\"forminator-field-checkbox-1-2-69ea6ba2a0c68\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"No\" id=\"forminator-field-checkbox-1-2-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-checkbox-1-2-69ea6ba2a0c68-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-1-69ea6ba2a0c68-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><span id=\"forminator-field-checkbox-1-69ea6ba2a0c68-description\" class=\"forminator-description\">I understand that for promotional purposes the Center videotapes and\/or takes photographs of program participants and facility users. I hereby release and permit the Center to utilize for said promotional purposes any videotapes and\/or photographs of my child, my family member(s) or myself engaged in facility activities and\/or general facility use.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69ea6ba2a0c68-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-69ea6ba2a0c68-label\" class=\"forminator-label\">I have read the terms and conditions of this Contract and agree to the terms and conditions herein. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-69ea6ba2a0c68-label\" for=\"forminator-field-checkbox-2-1-69ea6ba2a0c68\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Yes\" id=\"forminator-field-checkbox-2-1-69ea6ba2a0c68\" aria-labelledby=\"forminator-field-checkbox-2-1-69ea6ba2a0c68-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_69ea6ba2a0c68\" id=\"forminator-field-name-4_69ea6ba2a0c68-label\" class=\"forminator-label\">E-Signature of Participant or Parent\/Guardian <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"First and last name\" id=\"forminator-field-name-4_69ea6ba2a0c68\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69ea6ba2a0c68\" id=\"forminator-field-date-1-picker_69ea6ba2a0c68-label\" class=\"forminator-label\">Date <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"04\/23\/2026\" placeholder=\"\" id=\"forminator-field-date-1-picker_69ea6ba2a0c68\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"0\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p><i>Upon receipt of your program registration, we'll be in touch to confirm your class based on level of need and availability. Please note, depending on the day and time the registration is submitted, processing may take up to 72 hours. We appreciate your patience.<\/i><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha\" data-theme=\"light\"  data-sitekey=\"6LegVwIpAAAAAAt6Ae1DpD7oJofIhWaYZgrymxJ7\" data-size=\"normal\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"42ae380add\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/44068\" \/><input type=\"hidden\" name=\"form_id\" value=\"19310\"><input type=\"hidden\" name=\"page_id\" value=\"44068\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/berkshiresouth.org\/es\/forms-adaptiveaquatics\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_19\" class=\"forminator-hidden\" aria-hidden=\"true\">Por favor, no rellenes este campo. <input id=\"input_19\" type=\"text\" name=\"input_19\" value=\"\" autocomplete=\"off\"><\/label><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Inscripci\u00f3n Acu\u00e1tica Adaptativa \u00a1inscr\u00edbete hoy en tu programa de Acu\u00e1tica Adaptada! |un formulario por participante<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"Inscripci\u00f3n Acu\u00e1tica Adaptativa %%sep%% %%sitetitle%%","_seopress_titles_desc":"","_seopress_robots_index":"yes","site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"enabled","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-44068","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/pages\/44068","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/comments?post=44068"}],"version-history":[{"count":1,"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/pages\/44068\/revisions"}],"predecessor-version":[{"id":44069,"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/pages\/44068\/revisions\/44069"}],"wp:attachment":[{"href":"https:\/\/berkshiresouth.org\/es\/wp-json\/wp\/v2\/media?parent=44068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}