Swim Lessons Registration Form ● 1 LAWTON FAMILY YMCA Swim Lessons Saturday Dates: 4,11,18, 25 Fee: $30 Members/$45 Community Participant Lessons Time:  Parents & Child 9:00am - 9:45am  3 & 5 years old 10:00am - 10:45am  6 & up years old 11:00am - 11:45am 2 Participant Information  Y Member Player’s Name: Age Address State School **Ethnicity Military Parent/Guardian Information Active  Y Member **Ethnicity Military  None Active Retired Gender Zip Code  None Emergency Contact Contact’s Name:  / State Cell Phone #  Zip Code Retired / City Home Phone # 5 /  Community Participant DOB Address / Gender Parent’s Name: 4 DOB City Grade 3  Community Participant Relationship For Our Information How did you hear about swim lessons? Facebook  School Flyer Friend/Referral: ________________________________  Bulletin Board  Other: ___________________________________ ** Any information such as Ethnicity, Gender, and Age are collected for all current LFY Programs. **This data helps us apply for program grants and funding. THANK YOU! 6 E-Mail Alerts If you would like to sign-up for our E-Mail Alerts please indicate which program areas would you like to receive alerts about. Please also make sure your E-Mail address is clearly printed, and let us know which person’s E-Mail Address is being used. THANK YOU!  YMCA Youth Sports  Family Nights & Family Programs  School-Age Programs/Events  LFY Summer Day Camps  Swim Lessons & Swim Teams  Health & Wellness Programs/Events  YMCA Volunteer Opportunities  YMCA Memberships  Employment Opportunities E-Mail Address Whose E-Mail Address 7 Permission I hereby DO  DO NOT  give my consent for my child’s pictures to be taken and used for promotion purposes. This includes brochures, flyers, seasonal guides, videos, websites and any other promotional purpose as deemed appropriate by the Lawton Family YMCA. 8 Waiver & Agreement By signing below, I authorize the YMCA to provide emergency treatment. I recognize that participation in YMCA activities may expose my child to some risk of injury. I agree to hold the YMCA harmless of any claims of damage or loss of any property of injury to persons that may occur through participation in any activity at the YMCA or in its programs. Parent/Guardian Signature: ______________________________________________________________________________ Staff Only:  Cash  Credit Date: / Staff /  Check Notes: ** Any information such as Ethnicity, Gender, and Age are collected for all current LFY Programs. **This data helps us apply for program grants and funding. THANK YOU!