To Be Completed Only When a Full Registration Form Has Previously Been Received. For

ADDITIONAL LESSON REGISTRATION

To be completed only when a full registration form has previously been received. For information please contact Brandy Allen, Membership Director at

MEMBERSHIP INFORMATION
Household Registrant (parent or adult)
Surname / Given Name
Work Phone / Mobile
NAME OF OTHER HOUSEHOLD MEMBERS: / BIRTHDATE:
YY/MM/DD
(for children only) / CURRENT SWIM LEVEL / Private
(5 lessons)
Enter Instruction Level & Session / Session 1
(Jul 3 – Jul 14)
Enter Instruction Level / Session 2
(Jul 17 – 28)
Enter Instruction Level / Session 3
(Jul 31 – Aug 11)
Enter Instruction Level / Session 4
(Aug 14 – Aug 25)
Enter Instruction Level
2016 PAYMENT OPTIONS / AMOUNT / TOTAL
SWIMMING LESSONS: - space is limited, first registered–first placed
Group Lessons Member($40), Non-member($65) Private Lessons Member($70), Non-member($120) / (Select Option)
CASH CHEQUE - CHQ #
Cheques payable to Forest Edge Community Club (NSF Fees are responsibility of member)
Interac e-Transfer: (passwords to ) / GRAND TOTAL:

PRINT NAME: ______SIGNATURE: ______DATE: ______

For Office Use Only

Receipt #:______Issued: ______e-Transfer confirmation: PAID IN FULL in  on date:______

ADDITIONAL LESSON REGISTRATION

To be completed only when a full registration form has previously been received. For information please contact Brandy Allen, Membership Director at

PRINT NAME: ______SIGNATURE: ______DATE: ______

For Office Use Only

Receipt #:______Issued: ______e-Transfer confirmation: PAID IN FULL in  on date:______