Student Name(s):
__________________________________________________________________
Age(s):_________________________________
Parents Name:_________________________________
Address:__________________________________________________________________
City:_________________________________,
Zip:___________________
Telephone Number:_________________________________
Email Address:_________________________________
Emergency Contact Number:_________________________________
Release Form must be signed before class begins. Click
on link to download form:
RELEASE FORM
Swim Class Choices
□ Private Lesson
□
Semi-Private Lesson (2 students-any age-same level)
□
Small
Group Lesson ((3 students-any age-same level)
□
Regular Group Lesson (age 6 & up) (4-6 students - 6 & up)
□
Pre-School Aquatics: (age 4 & 5) (3-4 in group)
□
Parent & Child (age 6 months to 3 years)
□
Mom & Tot Learning Session
□
Swim Club
Swim Lesson Sessions
□
June 14th-June 17th (Regular Group, Pre-School
Aquatics, Parent/Child Aquatics)
□
9:30 Session
□
10:30 Session
□
July 12th - July 15th (Regular Group &
Pre-School Aquatics, Parent/Child Aquatics)
□
9:30 Session
□
10:30 Session
□
Small Group: Requested time &
date._______________________________
□
Semi Private: Requested time &
date._______________________________
□
Private: Requested time &
date.____________________________________
Preferred Instructor:
_________________________________
*Pre-payment is required to guarantee
your child's enrollment.
*If the child cannot complete a session
or does not cancel before the day of the 1st lesson, no refund will
be given or makeup days allowed.
*Some instructors will teach private, semi-private lessons
and small group in
the afternoon or evenings upon request.Total Amount:____________ (Please call us if you need assistance)
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