2015 CANORA SWIMMING POOL LESSON REGISTRATION FORM Name: ________________________________________________________________ Age: _______________ 1) Parents Names: _____________________________________________ Phone #: 2) ______________________ Address: ___________________________________________________Town: _________________________ Postal Code: _____________________SK Hospitalization Card #:____________________________________ In emergency, contact: ________________________________________Phone #:________________________ Tell us of any special medical conditions you may have: ____________________________________________ Please check mark () your choice of session dates. If you are enrolling in more than one session, please use separate forms. ALL lessons & passes must be paid in FULL at time of registration. NO registrations will be accepted without payment & NO post-dated cheques will be accepted!! Sorry for the inconvenience! th  Session 1 – June 15 to June 26th, 2015 Registration Deadline: June 1st, 2015    Session 2 – July 20th to July 31st, 2015 Registration Deadline: June 30th, 2015 Session 3 – August 3rd to August 14th, 2015 Registration Deadline: July 25th, 2015 Private Lessons – DATES & TIMES TO BE DETERMINED BY MANAGER AT A LATER DATE Date of preference: 1)_______________________ 2)__________________________  Monitored Lane Swim – to run twice/week (July & August) *Swimmers must have completed all levels of the Swim Kids program to take part. Please indicate which level of Red Cross Swim lessons you are enrolling in by  the level name/number: Swim Preschool *This program is designed for swimmers 4 months to 5 years of age.*  Starfish (Parental Supervision Required)  Salamander  Duck (Parental Supervision Required)  Sunfish (Level 1)  Sea Turtle (Parental Supervision Required)  Crocodile (Level 2)  Sea Otter  Whale (Level 3) Swim Kids Please circle the lesson you are enrolling in: *This program is for swimmers 6 years of age & older.* 1 2 3 4 5 6 7 8 9 10 Red Cross Assistant Lifeguard & Lifeguard courses may be offered in July and August, depending on interest. If you are interested in any of these courses, please contact the pool any time after May 4th, 2015. *PRICES & DATES of season passes, swimming lessons, private lessons and monitored lane swims are subject to change at any time* Parent/Guardian Signature: ___________________________________Date:_____________________________ OFFICE USE ONLY Season Pass Amount: $____________ Lesson Amount: $____________ Total: $____________ Receipt Amount: $____________ Receipt Number: #_______________________ Paid by: Cash Receipt Issued: Cheque Yes Credit Card No Monitored Lane Swim: With a pass $42.00 (+pass amount) Without a pass $48.00 Swimming Lesson Fees: With a Pass Preschool - $24.00 (+ pass amount) Levels 1-3 - $24.00 (+ pass amount) Levels 4-7 - $27.00 (+ pass amount) Levels 8-10 - $35.00 (+ pass amount) Season Pass Fees: Pre-school (Age 3-6) $ 25.00 Child (Age 7-14) $ 50.00 Student (Age 15-17) $ 64.00 Adult (Age 18+) $ 76.00 Family $151.00 Senior (55+) $ 69.00 Without a Pass Preschool - $47.00 Levels 1-3 - $47.00 Levels 4-7 - $53.00 Levels 8-10 - $64.00 Private Lessons: Preschool- Level 3 $100.00 / 2.5 hrs Level 4-6  $110.00 / 3 hrs & 45 mins Level 7-10 $122.00 / 5 hrs