SWIM LESSONS $50

JULY 15-25 (MONDAY - THURSDAY)

Parent & Child and PreSchool Levels - 6:00-6:30pm
Regular Levels 1-5 - 6:45-7:30pm

CLASS AVAILABILITY IS LIMITED, FIRST COME FIRST SERVE
PRIVATE LESSON REGISTRATIONS MUST BE MADE IN THE PARK OFFICE

PARTICIPANT'S NAME * First Last
BIRTHDATE * / MM / DD YYYY
AGE *
SEX *

SEX MALE FEMALE
MEDICAL CONDITION

PLEASE NOTE ANY CONDITIONS THAT INSTRUCTORS NEED TO BE AWARE OF BEFORE LESSONS BEGIN. ALL PARTICIPANTS MUST BE ABLE TO ENDURE A CLASSROOM SETTING WITHOUT DISRUPTION.
SELECT A LEVEL: *

SELECT A LEVEL: PARENT & CHILD LEVEL 1 PARENT & CHILD LEVEL 2 PRE-SCHOOL LEVEL 1 PRE-SCHOOL LEVEL 2 PRE-SCHOOL LEVEL 3 REGULAR LEVEL 1 REGULAR LEVEL 2 REGULAR LEVEL 3 REGULAR LEVEL 4 REGULAR LEVEL 5 REGULAR LEVEL 6

INSTRUCTORS RESERVE THE RIGHT TO PLACE PARTICIPANTS IN THE LEVEL THAT BEST FITS THEIR CAPABILITIES BASED ON THE AMERICAN RED CROSS LEARN TO SWIM EXIT LEVELS ASSESSMENT.
PARENT/GUARDIAN * First Last
PHONE * - ### - ### ####
RELATIONSHIP TO PARTICIPANT *
ADDRESS *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
EMAIL ADDRESS *
REGISTRATION CONFIRMATION
You will receive a email confirmation stating DPR received your registration form. If you do not receive confirmation of registration please contact the park office 573-624-8244, it is your responsibility to confirm receipt of registration form. If DPR does not receive your registration and you do not have proof of registration (screen shot or email) your registration will not be accepted.
PAYMENT OPTIONS *

PAYMENT OPTIONS Pay Online Pay in Park Office Payment left in drop box

All registration forms and payment must be received by the deadline.
Draw your signature into the box below. *

Clear
We, as parents/guardians of the above named child give our permission to his/her participation in this year's program. We assume all risks and hazards incidental to such participation in this program. We understand we are responsible for our child's transportation to games and practices and for the return of any uniform or borrowed equipment in our possession at the end of the season. Signing below gives Department of Parks and Recreation and its assigns, both during and anytime after, to use their likeness, name, voice, or words in either television, radio, film, newspaper, magazines, social media, and other media, and in any form, for the purpose of advertising or communication the purpose and activities of the Department of Parks and Recreation.