Swim Instructor Registration Form

Last Updated: 5/21/2017

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Pool Manager Email
Parent Name*
First Last
Parent Email*
Parent Phone*
Har-Ber Meadows Address*
Street Address Address Line 2 City State ZIP Code
Swimmer Information*
Swimmer Name Age

Please list the children (swimmers) here.
Swim Instructor Information*
First Last
MUST BE 18 YEARS OR OLDER
Swim Instructor Dates and Times*
Date Time

Please list dates and times of instruction.
NOTE: SWIM LESSONS CANNOT BE SCHEDULED FROM 11:00 AM to 5:00 PM
Email

Swimmer Name	Age

Date	Time