Swimtime

Swim Time

969 Spring Street Westbrook, ME
Mailing: 6 Caribou Drive Limerick, ME 04048
Phone: 772-6100


Registration Form

(Please Print) Date:_______________________________
Last Name:_______________________________________ First name:_____________________________________________
Age:_______________________________ Birthdate:__________________________________ Sex:______________________
Address: (Street)_____________________________, (City) _________________________, (State)_____, (Zip)______________
Mailing Address: (PO Box)______________________, (City)__________________________, (State)_____, (Zip)______________
Class:_________________________________ Day:_____________________ Time:___________________ Cost:___________
List any medical conditions we should know about (allergies, seizures, asthma etc…)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
(Child #2)
Last Name:______________________________________ First name:______________________________________________
Age:_______________________________ Birthdate:__________________________________ Sex:______________________
Class:_________________________________ Day:_____________________ Time:___________________ Cost:___________
List any medical conditions we should know about (allergies, seizures, asthma etc…)
______________________________________________________________________________________________________
_______________________________________________________________________________________________________
List any medical conditions we should know about (allergies, seizures, asthma etc…)
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Name of parent to notify:________________________________ Phone:____________________ Alt. Phone:_________________
Address: (Street)______________________________, (City) _________________________, (State)_____, (Zip)______________
Name of parent to notify:________________________________ Phone:_____________________ Alt. Phone:________________
Address: (Street)______________________________, (City) _________________________, (State)_____, (Zip)______________
There is a $15.00 registration fee per child annually, with a max of $45.00 a family. All children must have an adult present during class times. Lesson prices are first 2 children reg price and 1/2 off for remaining children.
Contact us: 772-6100