Aquatic Registration
Swimmer Information
Child #1
*
First Name
*
Last Name
*
Age as of 6/14/2010
*
Sex
M
F
*
Please indicate your child's swimming abilities & experience.
Yes
No
Not Sure
Still Afraid of the Water
Loves Water but Cannot Dog Paddle
Able to Dog Paddle
Can Swim in Deep End w/ Bubble
Can Swim in Deep End w/o Bubble
Needs to Improve Strokes
Allergies, Concerns, or Traumatic Water Experiences
*
Which swim sessions?
Session #1 for 3-5 year old
Session #1 for 6+
Session #2 for 3-5 year old
Session #2 for 6+
Session #3 for 3-5 year old
Session #3 for 6+
Session #4 for 3-5 year old
Session #4 for 6+
$110 per session for 3-5 year old
$90 per session for 6+
*
Fee ($)
Child #2
First Name
Last Name
Age as of 6/14/2010
Sex
M
F
Please indicate your child's swimming abilities & experience.
Yes
No
Not Sure
Still Afraid of the Water
Loves Water but Cannot Dog Paddle
Able to Dog Paddle
Can Swim in Deep End w/ Bubble
Can Swim in Deep End w/o Bubble
Needs to Improve Strokes
Allergies, Concerns, or Traumatic Water Experiences
Which swim sessions?
Session #1 for 3-5 year old
Session #1 for 6+
Session #2 for 3-5 year old
Session #2 for 6+
Session #3 for 3-5 year old
Session #3 for 6+
Session #4 for 3-5 year old
Session #4 for 6+
$110 per session for 3-5 year old
$90 per session for 6+
Fee ($)
Child #3
First Name
Last Name
Age as of 6/14/2010
Sex
M
F
Please indicate your child's swimming abilities & experience.
Yes
No
Not Sure
Still Afraid of the Water
Loves Water but Cannot Dog Paddle
Able to Dog Paddle
Can Swim in Deep End w/ Bubble
Can Swim in Deep End w/o Bubble
Needs to Improve Strokes
Allergies, Concerns, or Traumatic Water Experiences
Which swim sessions?
Session #1 for 3-5 year old
Session #1 for 6+
Session #2 for 3-5 year old
Session #2 for 6+
Session #3 for 3-5 year old
Session #3 for 6+
Session #4 for 3-5 year old
Session #4 for 6+
$110 per session for 3-5 year old
$90 per session for 6+
Fee ($)
*
Total Fees for all Participants:
Household / Adult Primary Contact
*
Relationship to Participants:
Mother
Father
Guardian
Other
*
First Name
*
Last Name
*
Address 1
Address 2
*
City
*
State
*
Zip
*
Home Phone
Alternate Phone
*
Email Address
*
Indicates Response Required