2019 Swimming Lesson Registration
This for is for registering one or more students for ONE session. You are welcome to register different students for different sessions, you will simply need to fill out another on-line registration.
Email address *
By submitting this form, I give my permission for the named person(s) to take swimming lessons at the Fairbank Aquatic Center (also known as The Fairbank Municipal Swimming Pool). I release the pool personnel, Fairbank City Council, Pool Board and City of Fairbank from any responsibility in the event of an accident due to his/her own negligence, disobedience or irresponsibility, or disregard for pool and/or city rules or policies.
I understand the above statement. *
Please Indicate the Session you are registering for *
Individual Completing This Form *
Your answer
Parent or Guardian Name *
Your answer
Street *
Your answer
City *
Your answer
Phone # *
Your answer
Emergency Contact: Name and Phone Number *
Your answer
Student 1
Student 1 First Name
Your answer
Student 1 Last Name
Your answer
Student 1 Age
Your answer
Student 1 Skill Level
Student 2
Student 2 First Name
Your answer
Student 2 Last Name
Your answer
Student 2 Age
Your answer
Student 2 Skill Level
Student 3
Student 3 First Name
Your answer
Student 3 Last Name
Your answer
Student 3 Age
Your answer
Student 3 Skill Level
Student 4
Student 4 First Name
Your answer
Student 4 Last Name
Your answer
Student 4 age
Your answer
Student 4 Skill Level
Payment Information
$30.00 for each student in levels I through VI
$15.00 for Minnows and Me
Total Amount Due *
Your answer
Payment Method *
Thank You!
A copy of your responses will be emailed to the address you provided.
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