Hood River Aquatic Center
Swim Lesson Registration Form

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: _______________________

Session 1:  June 23-July 3

Session2:  July 7-17

Session 3: July 21-31

Session 4:  August 4-14

Session 5:  August 18-29

Session A: June 2-19

Session B: July 8-24

Session C: August 5-21

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 class 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 payment options

• Anyone with a fever, infection, open wound, rash or any other contagious condition will not be allowed in the pool.

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

• 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 to due to improper placement, illness, or absence.

Please initial that you have read and understand these

policies: _____

Payment Options (circle option desired)

For Sessions A ,B ,C:

$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)

For Sessions 1-5:

$ 40 Lessons - swim lessons only

$46 Lessons  plus- swim lessons + swimming for child before or after swim lessons ($1 per swim)

$52 Lessons plus parent- Swim lessons + swimming for one parent and child before or after swim lessons ($1 per swim)

Please do not send cash through the mail.

Make checks payable to:  HRV Parks and Rec.

Amount: _______   Check number: ______