Form

Summer 2018 Learn To Swim Program
Parent's Name *

First Name Last Name
Parent's Phone Number - In Case of Emergency *

- Area Code Phone Number

Parent's Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please select one: *

In-District Out of District
How many children are you registering for the swim program? *

Child #1
Child #1 Full Name *

First Name Last Name
Child #1 Date of Birth *

- Month - Day Year
Child #1 Swim Level *
How many classes is this child attending? *
Class #1 Session *
Time #1 *
Class #2 Session
Time #2
Class #3 Session
Time #3

Child #2
Child #2 Full Name

First Name Last Name
Child #2 Date of Birth

- Month - Day Year
Child #2 Swim Level
How many classes is this child attending?
Class #1 Session
Time #1
Class #2 Session
Time #2
Class #3 Session
Time #3

Child #3
Child #3 Full Name

First Name Last Name
Child #3 Date of Birth

- Month - Day Year
Child #3 Swim Level
How many classes is this child attending?
Class #1 Session
Time #1
Class #2 Session
Time #2
Class #3 Session
Time #3

Child #4
Child #4 Full Name

First Name Last Name
Child #4 Date of Birth

- Month - Day Year
Child #4 Swim Level
How many classes is this child attending?
Class #1 Session
Time #1
Class #2 Session
Time #2
Class #3 Session
Time #3

Child #5
Child #5 Full Name

First Name Last Name
Child #5 Date of Birth

- Month - Day Year
Child #5 Swim Level
How many classes is this child attending?
Class #1 Session
Time #1
Class #2 Session
Time #2
Class #3 Session
Time #3

TOTAL
Total Number of Classes:
Should be Empty: