Hood River Aquatic Center
Summer 2012 Swim Lesson Registration Form -- In District

Child's name: _____________________________

Child's age: _____  Child's birth date:   __________

Parent's name: ________________________________

Address:  ____________________________________

City: ________________________________________

State: __________    Zip: __________

Phone number:___________________________

Day phone (if different):  ____________________

First Choice

   Session number:  _______________________

   Class time & title:   ______________________

Second Choice

   Session number:  _______________________

   Class time & title: _______________________

I agree to release, indemnify, and hold the Hood River Valley Parks and Recreation District, its agents, officers and employees harmless from any and all liability claims, actions, judgments, damages, or injuries of every kind and nature whatsoever to the participant and/or his property arising from participation in activities for which the participant is registering.

Parent/Guardian signature:

X________________________________________

      Children may only be registered for one session at a time.

      If you or your child wish to swim before or after the lesson, please pay at the front desk.**  Please see our different lesson options that include swimming before or after lessons.

      Children should not swim if they have a fever, infection, open wound, rash, or any other contagious condition. 

      The Hood River Aquatic Center reserves the right to cancel a class at any time due to an insufficient number of participants.  Credits and/or refunds will be issued.

      Classes may be combined in order to better accommodate participants.

      Requests to drop or change a class must be made 48 hours in advance to receive credit towards future pool programs.

      Credits or refunds will not be issued due to improper placement, illness, or absence.

      It is the parent's responsibility to enroll their children in the correct class.

Please initial that you have read and understand these

policies: _____

Payment Options (circle option desired)

Sessions 1-5, Morning Lessons

$40 Lessons — swim lessons only

$48 Lessons plus — Swim lessons + swimming for your child before or after swim lessons ($1 per swim)

$56 Lessons plus parent — swim lessons + swimming for one parent and your child before or after swim lessons. ($1 each per swim)

Session A-D, Evening Lessons

$30 Lessons - swim lessons only

$36 Lessons plus - swim lessons + swimming for your child before or after swim lessons ($1 per swim)

$42 Lessons plus parent - swim lessons + swimming for one parent and your child before or after swim lessons ($1 each per swim)

Please do not send cash through the mail.

Make checks payable to:  HRV Parks and Rec.

Amount: _______   Check number: ______

Added name to notebook: _____  Placed form in notebook: ____

Checked for signatures:_____   Staff initials: _____