Online and mail-in registration begins on 5/1/2018

Parent/Guardian:Home Phone:

Address: ______Cell Phone:

Email:______

*** Please include your email address above. ***

Child’s name / Class Session / Time / Level

*Times are subject to change due to enrollment*

FEE (Non-refundable): Resident:$85.00 per session; Non-Resident: $95.00 per session

After 6/15/2018, add an additional $5 to above rate.

Session I / Session II
July2nd– July 12th
(No July 4th) / July 16th – 25th
SESSION I-Daytime / SESSION I- Evening
10:30 – 11:00 AM – Levels 1 and 2 / 5:00-5:30 PM – Levels 1 and 2
11:10 – 11:40 AM – Levels 3, and 4 / 5:40-6:10 PM – Levels 3, and 4
11:50 – 12:10 PM – Levels 5 and 6 / 6:20-6:50 PM – Levels 5 and 6
SESSION II-Daytime
10:30 – 11:00 AM – Levels 1 and 2
11:10 – 11:40 AM – Levels 3 and 4
11:50 – 12:10 PM – Levels 5 and 6

(Checks payable to TOWN OF COLUMBIA)

CLASS SESSION: There are 8 days of lessons with the 9th day reserved for make-up if a lesson is cancelled due to inclement weather.

PLEASE NOTE:Swim-lessons are non-refundable. In the event of a schedule conflict or your child being unable to participate, we cannot be held responsible for missed days.

REQUIREMENT TO ENTER CLASS: A completion card or mastery of skills of previous level.

Level 1, Pre-School: An introductory class for children 3.5 to 5 years of age (prior to entering kindergarten). Children learn to go under water, float with assistance, and other basic skills. / Level 1: An introductory class for children who entered school (5+). Children will learn basic water skills such as bubble blowing, going under water, and floating with assistance.
Level 2: Building off the basic skills learned in level 1, children learn to float and glide on their own as well as the basics of crawl stroke. / Level 3: Building off of skills from level 2, children learn to refine their breathing technique and stroke work.
Level 4: Building off of the skills learned in level 3, children learn to refine strokes further, learn the basics of diving, and build endurance. / Level 5: Building off of level 4 skills, children further refine swimming and diving skills while building endurance.
Level 6: Building off level 5, children build endurance and develop a sustainable, powerful stroke. This class also has a focus on open water safety. / FULL CLASS DESCRIPTIONS will be provided on sign-up night or may be found online at columbiact.org by clicking on “Recreation.”

Class Descriptions

MAIL-IN REGISTRATION:

Town Hall

Parks and Recreation, Swim Lessons

323 Route 87,

Columbia, CT 06237

Town of Columbia Emergency Information and Consent Form

Medical Permission

(This information maybe given to your child’s counselor and/or group leader)

Does your child have any special needs, physical limitations, health problems, or allergies that his/her instructor/coach should be aware of? Please include anything that would help the instructors/coaches to properly educate your child. No _____

If yes, please describe ______

___

___

Parent Signature ______Printed Name ______Date ______

Participant’s Health Insurance Carrier & Policy #______

Doctor to Contact______

NamePhone

**In case of an emergency,

If I am not available, please call NamePhone

I give the volunteers and workers designated by the Columbia Recreation Department, permission to provide emergency first aid or to obtain emergency medical treatment for my son/daughter in the event that an injury occurs during an activity.

I hereby grant consent to any and all health care providers designated by the Columbia Recreation Department program to provide me any necessary medical care as a result of any injury/illness.

Signature ______Date: ______

PLEASE RETURN FORMS TO – Columbia Parks and Recreation Department – 323 RT 87 – Columbia CT 06237

For more information please call: 860-228-8513 or email .

Checks should be made payable to “Town of Columbia”

2018 Town of Columbia Beach

Waiver of Liability

Swim Lessons

Household Information

Name:______

Address:______

Town:______State:______Zip:______

Phone (Home):______Phone (Work):______

Emergency Contact: ______Phone (Cell)______

Participation in this activity may involve physical contact. Each user determines his or her level of participation. As with any physical activity, there is an element of risk which each participant must assume.

In consideration for participation in the program(s) listed above, I hereby knowingly and voluntarily waive, absolve, indemnify and agree to hold harmless the Town of Columbia, its departments, commissioners, supervisors, instructors, volunteers, and participants from claims arising out of injury to myself/ my child. And from participation in this program I grant permission to the Town of Columbia to utilize any medical emergency services deemed necessary to treat my child should I not be able to be reached. I also understand that the Town of Columbia does not provide medical insurance for participants.

______

Signature of Participant/Parent/Guardian Date

______

Printed Name