 |
Please Print and Complete
this Form and Mail with
a Cheque to: |
Jill Knudsen 35 Sheldrake Boulevard
Toronto, Ont. M4P 2B1
|
| Name:______________________________________ |
Date of Birth (y/m/d):____/__/__ |
Sex:__ |
| Address:___________________________________________________ |
Postal Code:_____________ |
| Phone:(____)____-________ |
Email:______________________________________________ |
| School Attending:____________________________________ |
Grade on December 31, 2009:_____ |
| Level: Please circle one in either the Preschool or Swim Kids-Levels 1 to 10. |
|
Preschool-Sea Turtle |
Preschool-Salamander |
Preschool-Sunfish |
Preschool-Crocodile |
Preschool-Whale | |
|
Level: |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
First Choice Day:_______________________Second Choice Day:_________________________
First Choice Time:______________________ Second Choice Time:________________________ |
RELEASE
The undersigned parent or guardian of in consideration of the child being accepted by the Lawrence Park Athletic Association as a member of the Red Cross/ Royal Life Swimming Programme, does hereby release and forever discharge the Lawrence Park Athletic Association, its officers and staff from all claims, loss, damage, expense or costs, howsoever incurred, whether due to sickness, injury, or otherwise, or damage to or loss of property which may at any time hereafter arise by reason of any act or omission of the Lawrence Park Athletic Association, its officers or staff, in the performance of their various functions in connection with the programme sponsored by the Association to teach swimming. |
| Dated at Toronto this _______ day of ________________, 20_____. |
| Name of Parent or Guardian:_________________________________________________ |
| Signature of Parent or Guardian:______________________________________________ |
|
Fees: $175.00 for Preschool and Levels 1 to 5 at Sunnyview Pool; $200.00 for Levels 6 to 10 at Glenview Pool. Please mail cheque to:
Jill Knudsen, 35 Sheldrake Blvd., Toronto, Ont. M4P 2B1 |
|
FOR OFFICE USE ONLY
Placement – CLASS_______________________TIME____________________
Amount Paid_______________________ Term I_____________ Term II_____________
|
| |
|
|