Parent's Name______________________________________ EMail:_________________

Address:_______________________________________Tel#____________________(H)

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

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

First Choice  Please circle desired Session(s) Please indicate Pool or Backyard
Mini A Mini B Mini C    Location:_____________Start Date:__________Time:________Cost:______

Tues Wed Thurs Session Location:_____________Start Date:__________Time:________Cost:______

Splashin Tot ABC Adv. Tot ABC  Location:_____________Start Date:__________Time:________Cost:______

Summer 1 Summer 2 Summer 3  Location:_____________Start Date:__________Time:________Cost:______

Second Choice  Please circle desired Session(s) Please indicate Pool or Backyard
Mini A Mini B Mini C    Location:_____________Start Date:__________Time:________Cost:______

Tues Wed Thurs Session Location:_____________Start Date:__________Time:________Cost:______

Splashin Tot ABC Adv. Tot ABC  Location:_____________Start Date:__________Time:________Cost:______

Summer 1 Summer 2 Summer 3  Location:_____________Start Date:__________Time:________Cost:______


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

First Choice  Please circle desired Session(s) Please indicate Pool or Backyard
Mini A Mini B Mini C    Location:_____________Start Date:__________Time:________Cost:______

Tues Wed Thurs Session Location:_____________Start Date:__________Time:________Cost:______

Splashin Tot ABC Adv. Tot ABC  Location:_____________Start Date:__________Time:________Cost:______

Summer 1 Summer 2 Summer 3  Location:_____________Start Date:__________Time:________Cost:______

Second Choice  Please circle desired Session(s) Please indicate Pool or Backyard
Mini A Mini B Mini C    Location:_____________Start Date:__________Time:________Cost:______

Tues Wed Thurs Session Location:_____________Start Date:__________Time:________Cost:______

Splashin Tot ABC Adv. Tot ABC  Location:_____________Start Date:__________Time:________Cost:______

Summer 1 Summer 2 Summer 3  Location:_____________Start Date:__________Time:________Cost:______


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

First Choice  Please circle desired Session(s) Please indicate Pool or Backyard
Mini A Mini B Mini C    Location:_____________Start Date:__________Time:________Cost:______

Tues Wed Thurs Session Location:_____________Start Date:__________Time:________Cost:______

Splashin Tot ABC Adv. Tot ABC  Location:_____________Start Date:__________Time:________Cost:______

Summer 1 Summer 2 Summer 3  Location:_____________Start Date:__________Time:________Cost:______

Second Choice  Please circle desired Session(s) Please indicate Pool or Backyard
Mini A Mini B Mini C    Location:_____________Start Date:__________Time:________Cost:______

Tues Wed Thurs Session Location:_____________Start Date:__________Time:________Cost:______

Splashin Tot ABC Adv. Tot ABC  Location:_____________Start Date:__________Time:________Cost:______

Summer 1 Summer 2 Summer 3  Location:_____________Start Date:__________Time:________Cost:______

Please Make Check Payable to: Pool School Plus                                       Total Cost:_________
No Refunds/Credit for June or Mini classes.