Take The Plunge - Information Signup
Thank you for your interest in Take The Plunge, a children's lap swim program offered by Richmond Swims. Although we don't have any sessions currently available, if you sign up here, we will notify you the next time we run this program.
Additionally, having a list of interested people helps us to raise funds and schedule new sessions.
Thank you for completing this form!
* Required
Parent's First Name
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Your answer
Parent's Last Name
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Your answer
Email address
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Your answer
Home Street Address
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Your answer
City
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Your answer
Zipcode
Your answer
Phone Number (w/area code)
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Your answer
Child's First Name
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Your answer
Child's Last Name
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Your answer
Child's Age
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Your answer
Child's Race
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African American
Asian/Pacific Islander
Caucasian
Hispanic
Latino
Mixed Race
Other
Required
School
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Chavez
Coronado
Ford
Lincoln
Nystrom
Peres
Washington
Other:
Does your child qualify for free or reduced lunch at school?
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Yes
No
Do any of these apply to the child's family?
Calworks
Section 8 Housing
Covered California/Medi-Cal
SNAP
Homeless Coalition
Family income at or below state poverty level
How did you find out about Take the Plunge?
*
School
Friend
Nextdoor
Other:
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