Swim by the C, SWIMMING LESSONS Registration Form

Swim by the C, SWIMMING LESSONS Registration Form
FALL SESSIONS 1, 2, 3

SESSION 1: September 13 – September 30, 2010
SESSION 2: October 4 – October 21, 2010
SESSION 3: October 25 – November 11, 2010

Please Print:

Swimmer’s name (Last, First): __________________________ Age: ______ DOB: ______________

Mother’s Name(Last, First): _____________________ Father’s Name(Last, First): _______________________

Home Phone: _________________ Work: _______________ Cell: ________________

►Address: (Please include your zip code)◄

Parents, please compete by placing a check mark on the appropriate line:

My Child is very frightened of the water: ________________

My Child is a beginner: _______(Has little to no pool experience, does not comfortably place face in water.)

My Child is Intermediate: _______ (Has some pool experience, already happily places face in water, swims unassisted underwater a short distance.)

My Child is Advanced: _______ (Has a lot of pool experience, swims confidently unassisted underwater several feet.)

►Parents Please Complete◄

I choose 2 day a week lesson schedule: ______ I choose 3 day a week lesson schedule: ______ I choose the 4 day a week lesson schedule: ______

My 1^st, 2^nd, 3^rd choice to swim: Morning__________ Afternoon ________ Evening ________

PLEASE CHECK THE SESSIONS YOU ARE ATTENDING:

FALL SESSION 1 ____ FALL SESSION 2 ___ FALL SESSION 3: ___

FALL SESSIONS SWIMMING LESSON FEES:
Swim 4 days a week: Mon thru Thurs: MBR=$150.00. NONMBR=$160.00
Swim 3 days a week: any 3 day combo: MBR=$120.00. NONMBR=$130.00
Swim 2 days a week: any 2 day combo: MBR=$80.00. NONMBR=$90.00
Annual Registration Fee:
1^ST swimmer same family $10.00, 2swimmers same family $15.00, 3 or more $20.00

MULTIPLE FAMILY DISCOUNT – 25% OFF SECOND AND 50% OFF THIRD CHILD

Crossgates Staff Personal Please Complete In Full:

Amount Paid: __________ Today’s Date: __________ Paid w/Check #: __________

Paid w/Cash-Amount: __________ Charge to Account: __________ Staff Initial: ______

When you have finished completing the front of this form in full, please turn over, carefully read the information on the back and sign. Cece will call you prior to the start of the session to confirm your swim time and days.

PLEASE MAKE CHECKS PAYABLE TO CROSSGATES FAMILY FITNESS