Lesson Registration Form
Please print the form below, complete all information, enclose your check or money order payable to Peddie Aquatics Association (PAA), and mail to the address below. Please note that classes are filled in the post-mark order that they are received, therefore you may not hand-deliver your form at the pool!
Click
here to open this form as Microsoft WORD document.
| Child's Last Name: | Parent's Name: | ||||
| Address: | |||||
| Home Phone: | Cell Phone: | ||||
| Email Address (pls include every time): | |||||
Note: You will receive a confirmation via email from the Peddie Aquatics Administrative Assistant. If your email preferences are set to block messages from unknown senders, you will miss this important information! |
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Child's
Name: |
Age: |
Class
Name |
Session
# |
Time |
Cost |
| So that we can serve you better, please note any medical and/or behavioral special needs for your child. | |||||
(Please
make all checks payable to PAA) Total Amount Enclosed: |
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Parent/Guardian Release I agree not to hold the Peddie School, The Peddie Instructors, The Peddie Aquatics Association or its agents responsible for any accidents or health problems that may occur while using the Peddie pool or Athletic Facility. I am aware of the risks involved with the use of a pool. My child(ren) have seen a physician in the last year and are able to participate in swimming activities. I have read the portion of this web site that states the parent guidelines, and I understand that there are no refunds for classes once the forms are sent in. Please initial here ____ if you do not want your child photographed for PAA promotional purposes only (names will not be used). |
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| Signature: | Date: | ||||
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| Red Cross Safety School |