REGISTRATION FORM
Swimmers Name: ___________________________________________ D.O.B:____________________________________ Age: _________Male______Female_________ Add:_______________________________________ City: ______________________________________ State: __________ Zip: _____________________ Phone: ___________ -_______________________ Email address:___________________________ Emergency Contact: ____________________ Emergency #:____________________________ Medical Conditions/ Special Needs: ____________________________________________ School Child Attends:___________________ Session: __________ (Example: Aug 6- Aug 16) Class/Level:___________ (Example: Polliwog) Time: ______________ (Example: 6:30-7:15pm)
I and the participant(s) release the YMCA and the owner of any off site premises under this program, and their staffs and agents, from responsibility in the event of injury or loss of personal items while participating in the YMCA program. In the event I cannot be reached in an emergency, I hereby give permission to medical personnel selected by the YMCA staff to secure and administer treatment, including hospitalization, and/or transportation for the participant(s) named above. The YMCA does not carry accident insurance on program participants. This completed form may be photocopied for future use deemed necessary by YMCA staff. I agree to allow photos of myself/children to be used by the YMCA for advertising purposes.
Mon/Wed (4 week lessons) December 319 (6 classes)
Saturday (4 week Lessons) December 1-22
Registration deadline November 29
January 7-30
Registration deadline November 29
January 5-26
Registration deadline January 3
February 4-27
Registration deadline January 3
February 2-23
Registration deadline January 31
March 4-27
Registration deadline January 31
March 3-23
JUST KEEP SWIMMING
Winter 2012-13 Swim Lessons
Registration deadline February 28
Registration deadline February 28
HENDERSONVILLE FAMILY YMCA
Tues/ Thurs (4 week lessons) December 4-20 (6 classes)
Private Lessons
Private Lessons are packaged in sets of 2, 4, or 8 half hour lessons Member Pkg 2: Pkg 4: Pkg 8: $30 $60 $100 Non-Member $40 $70 $130
810 6th Avenue West Hendersonville, NC 28739 P. 828 692 5774 ymcawnc.org
Registration deadline November 29
January 8-31
Registration deadline January 3
February 5-28
Registration deadline January 31
March 5-28
Registration deadline February 28
SIGNATURE: ________________________________________ Todays Date: _______________________
Parent/Child
6-36 months
Stroke School All Ages
Level 1: Swimmers refine their performance of the front and back crawl. They will begin to be able to swim 25 to 50 meters continuously. Swimmers will learn the basics of flip turns and starts for competitive freestyle and backstroke. Level 2: Swimmers continue to refine the front and back crawl and are introduced to the breaststroke including its turns and starts. Swimmers are steadily building endurance and learning to listen to instruction from a coach outside of the pool. Level 3: Swimmers refine their breaststroke while learning the beginnings of butterfly. Swimmers now have the endurance to swim 100 meters continuously. Swimmers refine all starts and turns in preparation to swim competitively.
Swimming Lesson Costs
WEEKDAYS Mon/Wed or Tues/Thurs (4 WEEKS 8 LESSONS) Member Non- Member Preschool Youth December $30 $30 $22.50 $55 $55 $41.25
INITIAL EACH BELOW
REFUND POLICY/PAYMENTS (Initial
SKIP: Also known as Parent/Child is a class we offer to help babies and young children get used to the water. It is a great class for children and parents to learn and play while interacting with one another.
Each)
______ Payments: Registration is on a first come, first serve basis. YMCA reserves right to cancel class with insufficient registration. Payment in full is required at registration. _______ Cancellation Policy: Some programs require a minimum number of participants to hold class. If minimum numbers are not met 3 days prior to first day of class, participants will be notified that class may be postponed or cancelled. If YMCA cancels, refund or on-line credit will be issued. _______ Refund Policy: Y Cancels Program 100% refund refund check will be issued within 10 business days. Participant Cancels Participant cancels prior to first class 100% refund - (Less $5.00 Administration Fee) Participant cancels after first class 50% refund - (Less $5.00 Administration Fee) Participant cancels after second class 25% refund - (Less $5.00 Administration Fee) Participant cancels after third class No refund.
Saturdays 10:15-10:45 am
Preschool 3-5 years old
PIKE: This class is for beginners. We work on basic strokes and becoming comfortable in the water. EEL: This class is for kids comfortable in the water. We learn how to swim without assistance and how to swim under water.
(There will be a $10.00 late registration
fee if registering after the deadline.)
SATURDAY LESSONS (4 WEEKS 4 LESSONS) Member Non- Member Parent/Child Preschool Youth $20 $20 $20 $35 $35 $35
Mon/Wed - 3:15pm - 3:55pm Mon/Wed - 6:30pm - 7:10pm Saturdays- 9:30am - 10:10am
Levels determined by swimming assessment prior to enrollment.
Youth 6-12 years old
Polliwog: This class is for beginner school age children to become acquainted with the water and learn basic stroke skills. GUPPY: This class focuses on free style, back stroke, side stroke, breaststroke, and elementary backstroke.
Stroke School
(3 WEEKS 6 LESSONS)
Tues/ Thurs: Level 1: 5:30 6:15 pm Level 2: 6:15 7:00 pm Level 3: 3:15 4:00 pm Member $45 Non- Member $55
(There will be a $10.00 late registration fee if registering after the deadline.)
There must be a minimum of 3 participants signed up to hold each class. We cannot shift students into other classes if you cannot attend the class you are scheduled for.
Tues/Thurs - 3:15pm - 3:55pm Tues/Thurs 6:30-7:10pm Saturdays -10:15-10:55am
