Type Full Name :

Sign With Hand

Last Name

Certification

Parent/ Guardian Information

Third Fee

Birthdate

Name/Relation

Learn-to-Swim: 10:45am - 11:15am (ages 6-9)

Session 2: Monday, June 19th - Friday, June 30th

Pre-School Aquatics: 10:00am - 10:30am (ages 3-5)

First Name

Second Fee

Application Fee

Participant/Child Details

Application Fees

Do You Have A Valid Pool Pass?

ZIP

Applicant Signature

First Fee

(select one)

By signing below, I certify that all of the information provided in this application is true and accurate:

Recreation Department
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}

Swim Lessons Application

Phone #

Address 2

Swim Session Details

Session 1: Monday, June 5th - Friday, June 16th

Swim Session Time Slot

(select one)

Age of Child

Session 3: Friday, July 7th - Friday, July 21st (NO Class on July 11th)

Address

Phone #

Pool Pass Reference #

Additional Questions?

Please Add Any Questions in The Box Below:

Learn-to-Swim: 10:45am - 11:15am (ages 10-12)

City

State

Email Address