Swimming Lesson Registration Form

Swimmer's Name

First NameLast Name

Swimmer's Age

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Resident fee $35Non-Resident fee $40Parent-Tot Resident fee $20Parent-Tot Non-Resident fee $25

Session 1: Monday, June 8 - Friday, June 19
10:30 - 11:00 a.m. 🌞Levels 1, 2, 3 & 6
11:00 - 11:30 a.m. 🌞Pre-School Swimmer (PSS) & Levels 2, 4 & 5
5:00 - 5:30 p.m. 🌞Pre-School Swimmer (PPS) & Levels 1, 3 & 5
5:30 - 6:00 p.m. 🌞Levels 1, 2 & 4

Session 2: Monday, July 6 - Friday, July 17
10:30 - 11:00 a.m. 🌞Levels 1, 2 & 6
11:00 - 11:30 a.m. 🌞Levels 1, 4 & 5
4:30 - 5:00 p.m. 🌞Levels 1, 2, 3 & 5
5:00 - 5:30 p.m. 🌞Pre-School Swimmer & Levels 1 & 3
5:30 - 6:00 p.m. 🌞Levels 2, 4 & 6

Session 3: Monday, August 3 - Friday, August 14
11:00 - 11:30 a.m. 🌞Pre-School Swimmer, & Levels 2, 3 & 6
11:30 - 12:00 p.m. 🌞Levels 1, 4 & 5
5:00 - 5:30 p.m. 🌞Pre-School Swimmer, Levels 1 & 3
5:30 - 6:00 p.m. 🌞*Parent-Tot, Levels 2, 4
*Parent Tot class only meets for two weeks on Monday, Wednesday, & Thursdays

Session 1 : June 8-19Session 2 : July 6-17Session 3 : August 3-14

Preferred Session

*Please Select your Preferred Level*

Parent's Name

First NameLast Name

Parent's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent's Email

example@example.com

Parent's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact & Phone Number

Please select yes if you will give permission to have photographs of your child taken:

We will contact you to confirm your swimmer’s spot.
We look forward to a fun Summer!

**You MUST Pay Before You Submit the Form**

**Please use the link below to submit your payment BEFORE you submit your Registration form**

https://www.paymentservicenetwork.com/PaymentPage.aspx?acc=RT23951

**The City of Boscobel does not provide insurance accident or hospital insurance for participants. Parents
should review their insurance policies for coverage.