Shireinu Instructional Swim Application 2025

Shireinu is partnering with Instaswimusa.com to arrange swim lessons for girls who are interested. Our goals are to develop swimming skills, teach water safety, and provide a safe, fun atmosphere to participants of all ages. Our instructor is a certified Water Safety Instructor (WSI) with over 40 years of experience as a swim instructor. For more info, visit: www.instaswimusa.com.

Swimming instruction is located at Torah Ohr of Roslyn’s pool: 52 MINEOLA AVE, ROSLYN.

Transportation will not be provided.

TIME: 5:30-6:30 PM

FIRST HALF DATES: July 1, 3, 7, 8, 14, 15, 21, 22
SECOND HALF DATES: July 28, August 4, 5, 7, 11, 12, 18, 19
Dates are tentative and subject to change (with advance notice).

* Family Name

* Street Address

* City

* State

* Zip Code

* Mother/Legal Guardian's Name

* Mother/Legal Guardian's Cell

* Mother/Legal Guardian's Email Address

This will be used as primary email for all communications.

* Child's Name

* Child's DOB

* Child's Grade in Sept. 2025

Instructional swim open for girls entering grades 1-3 only. (Possible exceptions may be made for those entering 4th grade, should there be enough slots).

* Session Applying For

Please Select OneFirst Half (8 Classes)Second Half (8 Classes)Full Summer (16 Classes)

Medical Conditions / Allergies

List any known condition(s) such as asthma, ADD, seizures, diabetes etc. List any known allergies, including allergies to medications. List any medications being taken.

Swim Level

List child’s swim background / current level. (i.e. beginner, had lessons previously, etc.)

CONTRACT AND TERMS OF AGREEMENT:

LIMITED SLOTS AVAILABLE. Applications will be processed on a first come, first served basis.
Instructional swim is open to those enrolled in Shireinu Summer Program 2025, and entering GRADES 1-3 ONLY. (Those entering 4th grade might be allowed to participate if there are enough slots).
Payments are non-refundable. No refunds or reductions will be made for absences, whether due to illness ח”ו, weather conditions, etc, unless the class was canceled by Shireinu. Should a child choose not to enter the water, the class will still be charged.
Children can participate in either session, regardless of whether they will be attending Shireinu that session or not.
Class dates are tentative and subject to change (with prior notice).
A minimum of 10 participants are required in order to form the class.

* I agree to the terms and conditions delineated above.

I agree to the terms and conditions delineated above.

HOLD HARMLESS AGREEMENT

My daughter(s) has/have permission to attend the Instructional Swim Sessions of Shireinu Summer Program, a division of Torah Ohr Hebrew Academy.

This agreement releases Torah Ohr Hebrew Academy and all its staff or volunteers from all responsibilities and liabilities relating to injuries that may occur, G-D forbid, during the summer program, both on or off the Torah Ohr campus, regardless of whether the injuries are caused by negligence or not.
By signing below, I forfeit all rights to bring a lawsuit against Torah Ohr Hebrew Academy or any of its staff or volunteers for any reason.
In addition, I give my daughters(s) permission to receive emergency medical treatment.
This agreement additionally releases Torah Ohr Hebrew Academy and the owners of the pools Shireinu will be using from all liability relating to injuries that may occur during the use of their pools. By signing this agreement, I agree to hold Torah Ohr Hebrew Academy and the owners of the pools entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence or not. In addition, I acknowledge the risks involved in swimming. These include, but are not limited to, drowning, losing consciousness, injuring oneself, G-d Forbid. I declare that my daughter is participating voluntarily, and that all risks have been made clear to me. Additionally, my daughter(s) does not have any conditions that will increase her likelihood of experiencing injuries while engaging in this activity.
By signing below, I forfeit all rights to bring a suit against Torah Ohr Hebrew Academy or the owners of the pools for any reason. In return, my daughter(s) will receive access to their pools along with Shireinu Summer Program. My daughter(s) will also make every effort to obey safety precautions. I will ask for clarification when needed.

* I, the undersigned, fully understand and agree to the above terms.

I, the undersigned, fully understand and agree to the above terms.

* Parent/Guardian Name

* Parent/Guardian Signature

* Date

* Payment Type

Select a Payment TypeCashCheckZelle to Shireinu@TorahOhr.comCredit CardPayment must be made in FULL in order for the application to be processed. THERE ARE LIMITED SLOTS AVAILABLE.

-Checks may be post-dated through August 2025.
-Credit Card payment plan may be set until August 30, 2025.

* Applying For Session

Please Select OneFirst Half Classes ($35 / Class)Second Half Classes ($35 / Class)Full Summer Classes ($35 / Class)

Please select a session. There are 8 classes per session.

Total Due

* I understand that my application will not be processed until Cash payment is received.

I understand that my application will not be processed until Cash payment is received.Payment can be dropped off at the Torah Ohr Office (hours below).

* I understand that my application will not be processed until Check payment is received.

I understand that my application will not be processed until Check payment is received.Checks may be post-dated through August 2025. Payment can be mailed or dropped off at the Torah Ohr Office (hours below).

* Check Payments

Please upload a picture of your Check / Checks in order to submit application.

* Zelle Payment Confirmation

ZELLE TO SHIREINU@TORAHOHR.COM
Please upload a screenshot of your Zelle payment confirmation in order to submit application.

CONTRACT AND TERMS OF AGREEMENT:

HOLD HARMLESS AGREEMENT

Torah Ohr Office 581-D Middle Neck Road, Great Neck Open 2-5 PM, Monday - Thursday

Torah Ohr Office
581-D Middle Neck Road, Great Neck
Open 2-5 PM, Monday - Thursday