Swim by the C,
SWIMMING
LESSONS Registration
Form
SPRING
2011
SESSIONS 1 and 2
LaQuinta
Location (on
service rd across from Sams)
Call Coach Cece to confirm your child’s time and days
Please Print:
Swimmer’s name: __________________________ Age: ______ DOB: ______________
Last First
Mother’s Name: _____________________ Father’s Name: _______________________
Last First Last First
Home Phone:
_________________ Work: _______________ Cell: ________________
►Street 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 1st, 2nd,
3rd
choice to swim: Morning__________ Afternoon ________ Evening ________
I have a home pool: ____
SPRING
SESSIONS
SWIMMING LESSON FEES:
Swim 4
days a week: Mon thru Thurs: $120.00
Swim 3
days a week: any 3 day combo: $90.00
Swim 2
days a week: any 2 day combo: $60.00
MULTIPLE
FAMILY DISCOUNT – 25% OFF SECOND AND 50% OFF THIRD CHILD
Cece’s
use: Amount Paid: __________ Today’s
Date: __________ Paid w/Check #: __________
Paid w/Cash-Amount: __________
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 SWIM BY THE C
Please
bring completed registration form and payment to your child’s first
swim class. Thank you.
Coach Cece Dugas