RE-REGISTRATION

Bob Ruth Re-Registration Form 2014

ONLY

Leave face down at bottom of pile on red clipboard

or Mail to:

This is a re-registration form, so your $15 deposit and $5 registration fee

should already be paid. No need to re-pay unless you lost your deposit due to cancellation

Bob Ruth Aquatics

1408 Avondale Ct
Tlh, Fl
32317

Name (swimmer #1) _________________________________________ Age: ___________

(See below for second/third child in same session)

2012/2013 school grade:_____

Birthdate:_____________

swimmer #2?________________________________________________ Age: ______

2012/2013 school grade:______

Birthdate:____________

Parent's Name: _____________________________________________________________

Address: __________________________________________________ Zip: ___________
Please check here if this is a new address/address correction ______

Home Phone: __________________ Work Phone: __________________ cell?________________

e-mail?_______________________________@___________________
Bob: <bobruthaquatics@embarqmail.com>

Ability??

(use most appropriate code from ABILITY LEVELS chart. Each level pre-supposes mastery of previous level.)

swimmer #1___________

swimmer #2____________

most recent class attended (pls list beginning date of most recent class):

swimmer #1_______________
When You Can Come:

swimmer #2____________

See CLASS SCHEDULE chart for available dates/times.

1st choice

DATE: __________________________

TIME: ________________/_______________
earliest you can come / latest you can stay

alternate choices

DATE: __________________________

TIME: ________________/_______________

DATE: __________________________

TIME: ________________/_______________

Please give the largest time span possible; note if certain times within it are better than others.
We really need a 2 hour time span to schedule
Dates/times listed here are considered a commitment. Give only dates/times you can be sure of.
If more dates/times become open, please call (no charge to add).

Any teacher preference? _________________________________ How important? ___________ (hi/med/low?)

Well assume your priority is date/time over teacher unless otherwise stated here _______________

***IMPORTANT: We cannot process any registration without this part signed***

No matter the ability level achieved through swimming lessons, I am fully cognizant that swimming can be a dangerous activity for
any young person if left unsupervised.
Further, I hereby authorize any representative of Bob Ruth/Maclay Aquatics to administer appropriate emergency care and/or have
the above named treated in the event of a medical emergency during his/her participation in Bob Ruth/Maclay Aquatics Swim Program.
In addition, I agree not to hold Bob Ruth Aquatics or Maclay School responsible for any such accidents.
Signature--->
____________________________________________

Up to 2 swimmers on this form, BUT separate form for each session