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 (3-5 students-any age-same level)
□
Pre-School Aquatics: (age 4 & 5) (3-5 in group)
□
Parent & Child (age 6 months to 3 years)
□
Mom & Tot Learning Session
□
Swim Club
Summer Swim Lesson Sessions
Sessions available Monday-Thursday starting June 13th thru July 18th
except for the week of July 4th. Session includes 4 days.
□
Parent/Child (6 mos-3 years)
Requested time & date:__________________
*25
minute lesson 9:30 am 10:30 am sessions.
□
Preschool (age 4 & 5): Requested time &
date________________________
*25 minute lesson 9:30 am 10:30 sessions.
□
Small Group: Requested time &
date._______________________________
*50 minute lesson 9:30 am or 10:30 am
sessions available
□
Semi Private: Requested time &
date._______________________________
*50 minute lesson 9:30 am or 10:30 am
sessions available
□
Private: Requested time &
date.____________________________________
*50 minute lesson 9:30 am or 10:30 am
sessions available
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.
Total Amount:____________ (Please call us if you need assistance)
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