Swim Instructor Registration Form Last Updated: 5/21/2017 Pool Manager Email Parent Name* First Last Parent Email* Parent Phone*Har-Ber Meadows Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Swimmer Information*Swimmer NameAge Please list the children (swimmers) here.Swim Instructor Information* First Last MUST BE 18 YEARS OR OLDERSwim Instructor Dates and Times*DateTime Please list dates and times of instruction.NOTE: SWIM LESSONS CANNOT BE SCHEDULED FROM 11:00 AM to 5:00 PMEmail
