Bob Ruth/Maclay Registration Form 2014

please attach $15.00 deposit & $5 registration fee (per swimmer)

mail form to:

these fees are one time per summer (see Start Here)

Bob Ruth Aquatics

1408 Avondale Ct
Tlh, Fl
32317-7432

separate deposit check for each swimmer; all reg fees in 1 check
make both checks out to: Bob Ruth Aquatics

Name (swimmer #1) _________________________________________ Age: ___________

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

2013/14 school grade:_____

Birthdate:_____________

swimmer #2?________________________________________________ Age: ______

2013/14 school grade:______

Birthdate:____________

swimmer #3?________________________________________________ Age: ______

2013/14 school grade:______

Birthdate:____________

Parent's Name: _____________________________________________________________

Address: __________________________________________________ Zip: ___________
Home Phone: __________________ Work Phone: __________________ cell?________________
e-mail?_______________________________@___________________
Bob: <BobRuthAquatics@embarqmail.com>

Ability??

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

swimmer #1___________

swimmer #2____________

swimmer #3______________

PLEASE add any additional information/qualifications you think I should know, including special learning considerations;
For beginners, please also describe any bad water experiences your child may have had)

attach note if you need more space

When You Can Come:

See CLASS SCHEDULE chart for available dates/times.

1st choice

DATE: __________________________

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

alternate choices

DATE: __________________________

TIME: ________________/_______________

Please give the largest time span possible; note if certain times within it are better than others, but pls give us a 2 hour span.
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 3 swimmers on this form, BUT separate form for each session