Swim Lesson (Tadpoles) Registration – Greenwood Park Bells Lake Community Club

Parent / Guardian Information

Parent/Guardian Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Are you a current member of GPBLCC?*

What Week Are You Beginning Lessons?

Week of June 19-23

Week of June 26-30

Week of July 3-7

Week of July 10-14

Week of July 17-21

Week of July 24-28

Swimmer Information

Please fill in all fields.

Name*

First Last

Date of Birth*

Starting Level*

Can your child jump into the water and swim back to the wall completely unassisted?*

Yes

No

Has your child ever passed the swim test for Greenwood Park Bells Lake before?*

Yes

No

Is your child currently enrolled in swim lessons over the winter months?*

Yes

No

If you said yes to the question above, please state where they were given lessons, and the duration (Weeks, Months, etc.) they were enrolled.

What are you looking for out of the Tadpoles Program?*

Examples: I want my child to be a better swimmer and more comfortable in the water. Our goal is for our child to be able to pass the Wibit Test at the club (50 free and 2 min. tread) Our final goal is to get our child on the swim team.

Payment Information

Swim Lesson Registration*

Price:

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Member Discount

$0.00

Total

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