Parent's Name______________________________________ EMail:_________________

Address:_______________________________________Tel#____________________(H)

Town:_____________________State: _____Zip:_______Tel#___________________(Cell)

Name of 1st Child:_______________________D.O.B.:________Swim Level:_______________

Class Preference:

1st Choice:

Fall Session:____________Location:_____________Day:__________Time:________Cost:______

Winter Session:____________Location:_____________Day:__________Time:________Cost:______

Spring Session:____________Location:_____________Day:__________Time:________Cost:______

2nd Choice:

Fall Session:____________Location:_____________Day:__________Time:________Cost:______

Winter Session:____________Location:_____________Day:__________Time:________Cost:______

Spring:____________Location:_____________Day:__________Time:________Cost:______

Name of 2nd Child:_______________________D.O.B.:________Swim Level:_______________

Class Preference:

1st Choice:

Fall Session:____________Location:_____________Day:__________Time:________Cost:______

Winter Session:____________Location:_____________Day:__________Time:________Cost:______

Spring Session:____________Location:_____________Day:__________Time:________Cost:______

2nd Choice:

Fall Session:____________Location:_____________Day:__________Time:________Cost:______

Winter Session:____________Location:_____________Day:__________Time:________Cost:______

Spring Session:____________Location:_____________Day:__________Time:________Cost:______

Name of 3rd Child:_______________________D.O.B.:________Swim Level:_______________

Class Preference:

1st Choice:

Fall Session:____________Location:_____________Day:__________Time:________Cost:______

Winter Session:____________Location:_____________Day:__________Time:________Cost:______

Spring Session:____________Location:_____________Day:__________Time:________Cost:______

2nd Choice:

Fall Session:____________Location:_____________Day:__________Time:________Cost:______

Winter Session:____________Location:_____________Day:__________Time:________Cost:______

Spring Session:____________Location:_____________Day:__________Time:________Cost:______

Please make check payable to Pool School Plus.    TOTAL COST:_________
Please send form with payment to: Lynn Tilley, 70 Bridle Path, N. Andover, MA 01845. Credits/refunds will be provided minus a $25 cancellation fee for any withdrawals. No credits/refunds for withdrawals after the 2nd class. Please use back of form for comments or concerns. You will only be called if you did not get into your 1st choice of class(es).Please feel free to email lynn at tills4@comcast.net for a confirmation one week prior to start date