Water Safety Patrol Swimming Lesson Registration Form
Participant’s Name:______Age:______
Parent’s Name______
(if participant is under 18 years old)
Address: ______
______Phone:______
Program Desired: Twice Per Week Once Per Week
Level of Lesson Desired:
q Parent/Toddler (min. age 1)
q Beginner 1 (min. age 3)
q Beginner 2
q Beginner 3
q Advanced Beginner
q Intermediate
q Swimmer
q Advanced Swimmer
q Water Masters (min. age 11)
q Lifeguard Training (min. age 15)
q Water Aerobics (adults)
Location of Lesson Desired:
q Lake Geneva (Riviera)
q Williams Bay
q Fontana
q Linn Pier
q Knollwood
q Buena Vista
q Robinson Hillside
Signature Required:
I (the undersigned) authorize the above named individual (the participant) to participate in the Geneva Lake Water Safety Patrol Swimming Lesson Program. I assume all risks and hold harmless the Geneva Lake Water Safety Patrol and all of its instructors and employees in the event of an accident or injury.
Signature of parent or authorized adult:______
Print name:______date:______
For office use only (do not write in this box)
Participant Name:______
Level:______Days:______
Lesson Time:______Location:______
Instructor:______