Tavistock Hills Swim Club

Tavistock Hills Swim Club

1400 Warwick Road, Barrington NJ, 08033

www.tavistockswim.com

LEARN TO SWIM REGISTRATION FORM – 2017 SEASON

CONTACT INFORMATION:

Parent’s First and Last Name:
Address:
Home Phone #: / Cell #:
Email Address:
Emergency Contact: / Phone #

SESSION DATES:

Session # / Session Dates / Fee
Session 1: / June 19, 20, 21, 22 and June 26, 27, 28, 29 / $60 / Session / Child
Session 2: / July 10, 11, 12 ,13, and 17, 18, 19, 20

SESSION TIMES:

Group # / Time
Group 1: / 11:30 – 11:50
Group 2: / 12:00 – 12:20
Group 3: / 12:30 – 12:50
Group 4: / 1:00 – 1:20

Please complete and choose the Session(s) / Group(s) you are registering for by June 3rd. Reminder: first come/first serve, space is limited

Swimmer’s Name / Sex
(circle one) / Date of Birth / Session
(circle one) / Group
First Choice
(circle one) / Group
Second Choice
(circle one)
M F / / / / 1 2 / 1 2 3 4 / 1 2 3 4
M F / / / / 1 2 / 1 2 3 4 / 1 2 3 4
M F / / / / 1 2 / 1 2 3 4 / 1 2 3 4
M F / / / / 1 2 / 1 2 3 4 / 1 2 3 4

Does your child have any physical, medical, or emotional issues that the will need to be made aware of to the coaches? If yes, please explain:

______

The cost of the Learn to Swim Program is $60 / session /child. Make checks payable to Tavistock Hills Swim Club and mail payment along with completed application to: Kathleen Owens / 229 Park Place / Audubon, NJ 08106

For Official Use: Instructor______Paid:______

4/8/2016