Swim Lesson Registration Form

1. Swim Lesson Registration Form Sign up TODAY!!!! Fall & Winter Group Session Info Times: 7:15 pm Session 1: September 12 – October 6 Session 2: October 17 – November 10 Session 3: November 28 – December 22 Session 4: January 9 – February 2 Session 5: February 13 – March 8 Session 6: March 19 – April 12 Session 7: April 23 – May 17 ~Each class is 30 minutes long ~All sessions are Monday and Thursday at one of the times listed above. Participants may only attend during the time specified on their signed registration form. Please note, any class may possibly be cancelled or rescheduled due to low enrollment. **Registrations close the Saturday prior to the session start date. Any registrations after that point, if possible due to openings, will incur a $5 late fee.** Fees: Group Lessons:$60 (8x30 minute lessons) Private Lessons: $120 per participant (4 x 30 minute lessons) **Semi Private: $100per participant (4 x 30 minute 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: (214) 240-5348 asisler818@yahoo.com www.swatswim.com (Please detach and return to office) Child’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) 1 2 3 4 5 6 7 Time: (Circle one) 6:30 pm 7:15 pm Level:(circle one) Par/Child Goldfish Tuna Flounder Porpoise Beta Trout Grouper Shark Requested Private or Semi-Private Lesson Time and Start date: ______________________ In case of emergency, I authorize Southwest Aquatics of Texas/DISD 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/DISD 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: _____