GSDSS Swim Lessons Program Application
This form is for members of the GSDSS to apply for our swim lessons programs.
Email address *
Name of member in need of lessons and DOB *
Your answer
Name of parent/guardian *
Your answer
Phone number where you can be reached *
Your answer
Emergency contact and phone number. *
Your answer
Does the applicant have a fear of water? *
Has the applicant had swim lessons in the past? *
By signing the application you acknowledge that the GSDSS will not be responsible for any injury that may be caused during lessons and is not responsible for the safety of participants. *
Once your application has been approved it will be sent to the YMCA swim instructors so they can contact you to schedule lessons. Do you consent for your application to be released to the swim instructor? *
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