Swim Lesson Registration Form

1. Swim Lesson Registration Form Sign up TODAY!!!! Spring Group Session Information Times: 7:15 pm Spring Session 6: March 19 – April 12 Spring Session 7: April 23 – May 17 All spring sessions are held on Monday and Thursday evenings unless otherwise specified. Classes are 30 minutes long Summer Group Session Information Times: 10:00 am. 11:00 am, 6:00 pm, 7:00 pm Summer Session 1: June 4 – June 14 Summer Session 2: June 18 – June 28 *Summer Session 3: July 3 – July 13 Summer Session 4: July 16 – July 26 Summer Session 5: July 30 - August 9 Summer Session 6: August 13 – August 23 ~All Summer sessions are Monday – Thursday at one of the times listed above. Participants may only attend during the time specified on their signed registration form. Each class is 40 minutes long. *Summer Session 3 will run Mon, Tues, Thurs, Fri for week one and Monday – Thursday for week two in observance of Independence day **Registrations close the Saturday prior to the session start date. Any registrations after that point, if possible due to openings, will incur a $10 late fee.** Class Descriptions are on reverse side Fees: Spring Group Lessons: $60 Summer Group Lessons: $70 Private Lessons: $120 per participant (4 x 30 min lessons) *Semi Private: $100per participant (4 x 30 min. lessons) *must provide group of 2-3 swimmers *DISD students & teachers will receive a $5 discount on each session with proof Check or cash only. Make checks payable to: Southwest Aquatics of Texas For more information call, email, or check out our website at: (972) 708-2370 / (214) 240-5348 asisler818@yahoo.com www.swatswim.com Each child will receive a t-shirt upon completion of their lesson session. Only 1 shirt per child. Participant’s Name: _________________________ D.O.B.: _____________Age: _____ Parent’s Name: _________________________ Emergency #: ____________________ **Must have emergency phone on person at all times during the lesson** Address: _______________________________ City, State, Zip: __________________ Phone : __________________________ Email: ________________________________ Session: (Circle one) Spg 5 Spg 6 Spg 7 Sum 1 Sum 2 Sum 3 Sum 4 Sum 5 Sum 6 Time (summer session only): (Circle one) 10:00 am 11:00 am 6:00 pm 7:00 pm Level:(circle one) Par/Child Goldfish Tuna Flounder Porpoise Beta Trout Advanced Adult T-shirt Size: (circle one) YM YL AS AM AL How did you hear about our program: __________________________________________ Requested Private or Semi-Private Lesson Time and Start date: ______________________ In case of emergency, I authorize Southwest Aquatics of Texas/Duncanville Natatorium staff to administer first aid to the swimmer named above and/or take him/her to a physician or hospital for further treatment. I agree not to hold Southwest Aquatics of Texas/Duncanville Natatorium liable if my child is injured while participating in swim activities. Parent Signature: ____________________________ Date: __________ Office use only: Amt Pd:______ Cash / Check (circle one) Check #: _____ Staff Initials: _____