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:_______________________________