Centerville Swimming Lessons 2018 Sign-up
*Please fill out this information to enroll your child in the appropriate level for swimming lessons for 2018 ONLY if you know the level your child will be going into. You must fill out a separate form for each child that you wish to enroll in lessons. Classes are held M-Th, July 9-19, and will be limited to 20 students. Please PM Sylvia Kroger on her FB page if you need to know which level to place your child in or if you have any questions. Thanks!
Your child's first name *
Example: Jon
Your answer
Your child's last name *
Example: Smith
Your answer
Has your child received lessons at the Centerville Swimming Pool before? *
Required
Your Child's Age as of June 1, 2018 *
Example: 8
Your answer
Please choose the level in which you are enrolling your child (please choose one only). Note: if sections become large, we will create two sections, and you will be notified of the change. *
Required
Please include any health concerns or any other information for the instructors which will help us to most effectively help your child. *
Example: allergic to bee stings.
Your answer
Please leave an emergency contact name (first and last). *
Your answer
Please leave an emergency contact phone number. *
Your answer
Please include an email address at which you can be reached. *
Your answer
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