gray eagle private signup_2015

Gray Eagle Private Lesson Sign-up
Swimmer’s Name: __________________________________________________________________
Swimmer’s Birthdate: _______________________ Age: __________________
Sex: M
F
Parents’ Names: ___________________________________________________________________
E-mail Address: ___________________________________
Home Phone:___________________ Cell or Emergency Phone: ______________________________
Please indicate the 2 week
session you are registering
for:
___ Session 1:
June 1-5 and
June 8-12
___ Session 2:
June 15-19 and
June 22-26
___ Session 3:
July 6-10 and
July 13-17
___ Session 4:
July 20-24 and
July 27-31
Rates per session: 6 thirty-minute lessons per session.
Private:
$120
Semi-Private: $90 per child
Requested Teacher: ____________
Level Selected: _________
*Checks are payable to Gray Eagle Pool and Tennis Club and are
due one week before a scheduled session.
Swim Lesson Days-please circle preferred day.
Monday
Tuesday
Wednesday
Thursday
Friday
Swim Lesson Times-please circle preferred time.
10am 10:30am
11:00am
11:30am 5pm 5:30pm
6pm 6:30pm
Follow-Up by Swim Instructor
Lessons Completed: _________
Please note final level after completion of swim lessons.
*Instructors will notify you if lessons are cancelled due to
inclement weather.
LEVEL SELECTION -Below is a brief description of the different class levels. Please help us determine which level your child should be
in. The skills listed to the right of the level are the skills that the swimmer should achieve before moving to the next level. In other words, pick
the level that most represents the skills that your child is ready to take on and master.
Level I- Bubbles: water adaptation, movement in the water, blowing bubbles underwater
Level II- Floats & Glides: front float/glide and recover, back float/glide and recover
Level III- Kicking*: front kick, back kick, dolphin kick (*This group must be able to float without assistance from instructor).
Level IV- Crawl Stroke: crawl arm stroke, rollover from front to back, rollover from back to front, side-kicking
Release for Participation
I give my child, ___________________________ permission to participate with the Gray Eagle Swim Lesson Program for the summer of
2015. I fully understand that if my child is injured in any way, I will not hold the Gray Eagle Swim Lesson Program, Gray Eagle Pool and
Tennis Club, Gray Eagle Pool Management LLC., D&M Golf Management LLC., and/or RN Thompson Development Corp. responsible. I
understand that if my child is unable to attend a scheduled lesson that I must contact the Pool Office at least 2 hours prior to the start of the
lesson. I understand that missed lessons, no shows or late cancels can’t be made up.
Signature (Parent/Guardian)______________________________________________________ Date:_______________________________