BCAC Swimming Lessons Form

Registration Form

Name*
Student's First Name Student's Last Name
Student's Age*
Parent's Name*
Work #*
Home or Cell#*
Emergency Contact*
Level of Swimming Ability (Check One)*
- Advanced Beginner
- Beginner
- 3,4,or 5 year old
Children will be tested the first day of class
Date of Class to be taken*
MM slash DD slash YYYY
Parent or Guardian Signature*
Name
Date of Form*
MM slash DD slash YYYY