The Superior YMCA invites all elementary school-aged children to participate in our FREE drowning prevention program created by YMCA of the USA.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Date of Birth *
Current grade in school *
Which session are you registering for? *
Has this child ever had a swim lesson before? *
Can this child jump into water and safely exit the pool on his or her own (without flotation devices)? *
Has this child participated in any Superior Y programs before? *
May we take photos of this child for use in promoting future Y programs? *
Parent's Email Address *
Your answer
Digital Signature (Parent first name, last name) *
I hereby give my permission and for the above-named child to participate in Safety Around Water activities. I assume all risks and hazards incidental to such participation, and I release the YMCA, supervisors, and instructors from any claim arising from an incident or injury to my child. My first and last name typed below will serve as my digital signature.
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