New Underwood, South Dakota

......a good place to be!
 

2018 Swimming Lessons Registration Form

2018

SWIMMING LESSONS REGISTRATION

 

Name___________________________________   Age________________

 

Parent/Guardian Name_________________________________________

 

Address______________________________________________________

 

Phone Number________________________________________________

 

E-mail address________________________________________________

 

Emergency Contact ____________________________________________

 

Allergies?_____________________________________________________

 

Swimming Ability:

 

Are you comfortable in the water?________________________________

 

Can you put your face in the water?   ____________________________

 

Can you float?_________________________________________________

 

Have you had lessons before?____________________________________

 

If so, what was the last level completed?___________________________

 

Swimming Session Date________________________________________

 

Cost for each session is $15.00.

 

1st session:  

2nd session: