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Serving the youth of our communities through education, preservation, and recreation

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CLASSES
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ARC Swim Lesson Registration

PLEASE NOTE: There is a KNOWN PROBLEM with FIREFOX.
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All fields are required.


Name:                Birth Date: Age:
Street Address:    
City:                    State:  Zip Code:
Phone (with area code):     
Email address:   

Session Select Time (select one time slot for each session)
Session 1: June 7-June 17 CLOSED
Session 2: June 21-July 1 Level 1 Level 2 Level 3 Level 4
    5:30-6:00 6:15-6:45 7:00-7:30
  Level 5 Level 6
    5:30-6:30 6:45-7:45
Session 3: July 5-July 15 Level 1 Level 2 Level 3 Level 4
    5:30-6:00 6:15-6:45 7:00-7:30
  Level 5 Level 6
    5:30-6:30 6:45-7:45
Session 4: July 19-July 29 Level 1 Level 2 Level 3 Level 4
    5:30-6:00 6:15-6:45 7:00-7:30
  Level 5 Level 6
    5:30-6:30 6:45-7:45
Session 5: August 2-August 12 Level 1 Level 2 Level 3 Level 4
    5:30-6:00 6:15-6:45 7:00-7:30
  Level 5 Level 6
    5:30-6:30 6:45-7:45
Session 6: August 16-August 26 Level 1 Level 2 Level 3 Level 4
    5:30-6:00 6:15-6:45 7:00-7:30
  Level 5 Level 6
    5:30-6:30 6:45-7:45

Guardian/Emergency Information
Parent/Guardian Name:       
Home Phone with Area Code:                      
Work/Cell Phone with Area Code:    

Emergency Contact Name:    Relationship:
Home Phone with Area Code:                      
Work/Cell Phone with Area Code:    

Does the participant have a history of or currently have any physical limitations that might prevent him/her from fully participating in any classes?  Yes  No
If yes, please describe below.  If none, state "NONE"

Please list any special medications, allergies to food or drugs or any other pertinent medical information.  If none, state "NONE"


 
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Copyright © 2008-2009 Cabrillo Beach Youth Waterfront Sports Center
Last modified: Wednesday, June 9, 2010 9:44 PM