Summer Camps Registration 2010

Magenta fields are required.

Current Family Past Family New Family

Parents’ Names:

E-mail address:

Address:

City:

State:

Zip:

Phone:

Alt Phone:

How did you hear about us?

1st Swimmer’s Name:

Birthday:

Level:

2nd Swimmer’s Name:

Birthday:

Level:

3rd Swimmer’s Name:

Birthday:

Level:

Summer Swim Options (Check All That Apply)	Swimmer 1	Swimmer 2	Swimmer 3

Science Camp #1 (7/12–7/15) 4 days 1–3:30pm
Science Camp #2 (8/2–8/5) 4 days 1–3:30pm
Adventure Camp #1 (6/21–6/24) 4 days 1–3:30pm
Adventure Camp #2 (8/16–8/19) 4 days 1–3:30pm
Pool Party #1 (6/14–6/17) 4 days 1–3:30pm
Pool Party #2 (7/26–7/29) 4 days 1–3:30pm
Mighty Mini #1 (7/6–7/8) 3 days 1–3pm
Mighty Mini #2 (8/24–8/26) 3 days 1–3pm
One-on-Ones (Specify dates and times)

Tuition Information

First Camp per Child: $100 (MM Camp $75)
Second Camp per Child: $50 (MM Camp $75)
One-on-ones $16 per 30 minute private lesson

Tuition:

Credit Card:

Visa Master Card Discover

Name on card:

Exp:

Special Instructions/Comments:

Release
In consideration for Wise Swim School accepting my child into its program, I agree to assume all risks, costs and loses sustained by my child, myself and our guests in connection with the use of the Wise Swim School facility. I give permission to Wise Swim School and/or appropriate medical personnel to perform, at my expense, any emergency procedures judged necessary for the care and protection of my child while under the supervision of Wise Swim School. *We reserve the right to cancel/combine classes. Teacher requests can me made but are not guaranteed.

Please type an “x” in the box to indicate your agreement.



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