Swim by the C, SWIMMING LESSONS Registration Form

SPRING 2 and SUMMER SESSIONS 1,2,3

LaQuinta Location (on service rd across from Sams) 2011

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)◄

Please list any health concerns:____________________________________________

Emergency Contact and phone:____________________________________________

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 ________

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

When you have finished completing the front of this form in full, please turn over, carefully read the information on the back and sign.

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