Child's Information
First Name:
Last Name:
Age:
Choose one
4
5
6
7
8
9
10
11
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13
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17
18
Date of Birth:
Month
Choose one
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
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4
5
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13
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31
Year
Choose one
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
Phone:
Address:
City:
State:
Zip:
Available Class Times:$50 per session
My child would like to attend the following session of Swim Lessons:
(Choose Either Tuesday or Thursday and the time you would like)
Session One
March 27 - May 29
Session Two
March 29 - May 31
Day: Tuesdays
Day: Thursdays
Choose a time:
4 - 4:30 P.m.
4:30 - 5 p.m.
Choose a time:
4 - 4:30 P.m.
4:30 - 5 p.m.
Will a gift certificate be needed?
Yes
No
Skill Level
Choose the appropriate skill level for your child:
(For more information about levels,
click here
)
Level 1
Level 2
Level 3
Level 4
Medical Information
Does your child have any medical concerns?
Yes
No
Please list any and all conditions and concerns in the box below:
Emergency Contact Information
Mother's Name:
Work Phone:
Home Phone:
Father's Name:
Work Phone:
Home Phone:
Emergency Contact Name & Relationship:
Work Phone:
Home Phone:
Print, Sign and Remit Payment
Please print and sign the following form and remit with your payment. Remember you must either mail or bring in your payment to the Civic Center within
5 business days
of submitting this form for your registration to be valid.
Class space is
not
confirmed until payment is received.
Swim Lesson Consent and Release Form
Make checks or money orders payable to:
City of Oak Ridge
Remit Payment to the following address:
Attention: Swim Lesson Payment
City of Oak Ridge Recreation and Parks Department
P.O. Box 1
Oak Ridge, TN 37831
**Refunds will be considered on a case by case basis and must be submitted at least 1 week before class begins.**
Please Note The Following Information
Classes cancelled due to weather conditions will not be rescheduled or refunded.
Attention: This registration is
not
a real time registration process. Please indicate below if you would like to be contacted by phone or email to let you know that your registration is complete.
Phone
Email Email Address:
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