TOWN OF SARATOGA

2018 Swimming Lesson Registration Information

Registration forms� for the Town of Saratoga Swim Program can be dropped off at Curtis Lumber� 30 Saratoga Street in Schuylerville� from 7am-5pm Monday through Friday and Sat. 8am � 3pm. Ask� for BIG MIKE� The free program is for any student in the Schuylerville Central School District.� Classes will be conducted in a New York State Health Department approved lake at the Christ the King Spiritual Life Center on Burton Road in the Town of Easton and will be conducted Monday thru Friday in the mornings from July 2 to August 3.� Following registration, students will be notified of the time at which their one-half hour long class will be scheduled.�� Forms should be dropped off by JUNE� 22^rd

Any questions call Big Mike @518-932-2219 or email [email protected]

Registration Form

(Minimum age of 5 years old)

Name of Student:___________________________________� Date of Birth: _______________

Name of Parent: _______________________________________________________________

Address: ______________________________________________________________________

�_____________________________________________________________________________

Town of Residence ______________________E-Mail Address ____________________________

Home Phone #:_______________________________� Work Phone #:______________________

Emergency Contact:___________________________ Phone # :___________________________

Swimming Level: ________________________________________________________________

Years of Swimming:______________________ Lesson Experience :_________________________

________________________________________________________________________________

Health Concerns/Comments:_______________________________________________________

Student #2

Name of Student:___________________________________� Date of Birth: _______________

Name of Parent: _______________________________________________________________

Address: ______________________________________________________________________

�_____________________________________________________________________________

Town of Residence _____________________E-Mail Address ______________________________

Home Phone #:_______________________________� Work Phone #:______________________

Emergency Contact: ___________________________ Phone #: ___________________________

Swimming Level: ________________________________________________________________

Years of Swimming______________________ Lesson Experience: _________________________

________________________________________________________________________________

Health Concerns/Comments:_______________________________________________________

______________________________________________________________________________

� Please use the back of this page if you have more than two children that will be participating in the program.