| SWIMMING CLASS REGISTRATION |
__________________________________ ______________________________
Child's Name Child's Age
__________________________________ ______________________________
Parent's Name Child's Date of Birth
__________________________________ ______________________________
Address Home Phone
__________________________________ ______________________________
City Cell Phone
__________________________________ ______________________________
State Zip Code Parent's E-mail
____ SESSION 1 _____ AGE 3-5 ____ AGE 6-9____AGE 9-12 $80.00
____ SESSION 2 _____ AGE 3-5 ____ AGE 6-9 ____ AGE 9-12____ADULT $80.00
____ SESSION 3 _____ AGE 3-5 ____ AGE 6-9 ____ AGE 9-12 $80.00
____ SESSION 3 _____ FAMILY _____ NUMBER PARTICIPATING $50.00
____ SESSION 4 _____ AGE 3-5 ____ AGE 6-9 ____ AGE 9-12 $80.00
____________________________________
Parent's Signature
Class sizes are limited to keep the classes enjoyable and comfortable for all participants.
Please register early to ensure a spot, as registrations are on a first-paid basis. Please
mail completed registration form and payment to:
LAURA BLUM
P.O. Box 174
Milton, LA 70558
Return to Swim Home
Child's Name Child's Age
__________________________________ ______________________________
Parent's Name Child's Date of Birth
__________________________________ ______________________________
Address Home Phone
__________________________________ ______________________________
City Cell Phone
__________________________________ ______________________________
State Zip Code Parent's E-mail
____ SESSION 1 _____ AGE 3-5 ____ AGE 6-9____AGE 9-12 $80.00
____ SESSION 2 _____ AGE 3-5 ____ AGE 6-9 ____ AGE 9-12____ADULT $80.00
____ SESSION 3 _____ AGE 3-5 ____ AGE 6-9 ____ AGE 9-12 $80.00
____ SESSION 3 _____ FAMILY _____ NUMBER PARTICIPATING $50.00
____ SESSION 4 _____ AGE 3-5 ____ AGE 6-9 ____ AGE 9-12 $80.00
____________________________________
Parent's Signature
Class sizes are limited to keep the classes enjoyable and comfortable for all participants.
Please register early to ensure a spot, as registrations are on a first-paid basis. Please
mail completed registration form and payment to:
LAURA BLUM
P.O. Box 174
Milton, LA 70558
Return to Swim Home
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