Parker Pool Swim Lesson Registration Form
Please fill out the below form to sign up for swim lessons with Parker Pool Summer of 2017.
Email address
Parent/Guardian's Name
Your answer
Swimmer's Name
Your answer
Swimmer's Birthday
MM
/
DD
/
YYYY
Swimmer's Level
Please describe how your swimmer swims now:
Your answer
Contact Number
Your answer
Sessions (Exact times for half hour lessons will be emailed.)
Required
Group lessons are $40 paid by cash or check delivered to the pool by the Friday prior. The fee is $41.20 if paying by PayPal.
Required
Does this swimmer have any allergies?
Your answer
Please share any special needs or information that would be beneficial for us to know about the child:
Your answer
I understand the inherent risk of injury involved in participation in this sports program and verify that my child is medically fit to participate. I give my permission to the supervisors of this program to take the proper steps in case my child is in need of emergency medical attention. I also release the sponsoring groups and their agents from any and all claims arising from this child's participation in this activity.
Required
I grant the right to Parker Pool Management to take videos of me and parties to which I am legal guardian to use such video for any lawful purpose, including publicity, illustration, advertising, social media and web content. Participant or Parent/Guardian of the Participant(s) understands that photos and video are occasionally taken for promotional and marketing purposes.
Required
Classes will be set up the Friday morning prior to start date so please check your email for your exact lesson time. Please offer any comments, suggestions, or concerns. Thank you for your support!
Your answer
Please complete the captcha before submitting the form.
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