Winter 2011 Lesson Registration Form

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Winter 2011 Lesson Registration Form Powered By Docstoc
					                                                   Weyburn Leisure Centre
                                               RED CROSS SWIMMING LESSONS
                                                        Winter 2011

                                       Registration Form
Registration Information:
Participants Name: ____________________________________________________________

Address: _______________________________________________________________________________

Province: ___________________________ Postal Code: _________________________________________

Parent/Guardian Name: ____________________________________________________________________

Phone (Home): ___________ Phone (Work): ________ Email: ___________________________________

Birth date: _______________                 Level: ______________                    Session/Time: __________________________

Registration Information:
Participants Name: ____________________________________________________________

Address: _______________________________________________________________________________

Province: ___________________________ Postal Code: _________________________________________

Parent/Guardian Name: ____________________________________________________________________

Phone (Home): ___________ Phone (Work): ________ Email: ___________________________________

Birth date: _______________                 Level: ______________                    Session/Time: __________________________

Lessons
January 10th – February 9th (Mondays & Wednesdays) (10 Classes)
Starfish/Duck (10.00 – 10.30):           $43                         Salamander (5.30 – 6.00)                                $43
Starfish/Duck: (5.00 – 5.30):            $43                         Sunfish (5.00 – 5.30):                                  $43
Sea Turtle (11.00 – 11.30):              $43                         Crocodile/Whale (4.30 – 5.00)                           $43
Sea Turtle (5.30 – 6.00):                $43                         Level 1 (4.00 – 4.30):                                  $50
Salamander (10.30 – 11.00):              $43                         Level 6/7 (3.45 - 4.30):                                $55
Salamander (4.30 – 5.00):                $43

January 11th – February 10th (Tuesdays & Thursdays) (10 Classes)
Starfish/Duck (6.00 – 6.30):             $43                         Level 2 (4.30 - 5.00):                                  $50
Sea Turtle (6.30 – 7.00):                $43                         Level 2 (4.50 - 5.20):                                  $50
Salamander (5.30 – 6.00):                $43                         Level 3 (4.00 - 4.30):                                  $50
Sunfish (5.25 – 5.55):                   $43                         Level 4 (4.45 – 5.15):                                  $50
Crocodile/Whale (6.00 - 6.30):           $43                         Level 5 (4.15 – 4.45):                                  $50
Level 1 (5.00 – 5.30)                    $50                         Level 8/9/10 (4.00 - 4.45):                             $81

February 28th – March 30th (Mondays & Wednesdays) (10 Classes)
Starfish/Duck: (5.00 – 5.30):            $43                         Sunfish (5.00 – 5.30):                                  $43
Sea Turtle (5.30 – 6.00):                $43                         Crocodile/Whale (4.30 – 5.00)                           $43
Salamander (4.30 – 5.00):                $43                         Level 1 (4.00 – 4.30):                                  $50
Salamander (5.30 – 6.00)                 $43                         Level 6/7 (3.45 - 4.30):                                $55

March 1st – March 31st (Tuesdays & Thursdays) (10 Classes)
Starfish/Duck (10.30 – 11.00):           $43                         Level 2 (4.50 – 5.20):                                  $50
Sea Turtle (11.30 – 12.00):              $43                         Level 3 (4.15 – 4.45):                                  $50
Sea Turtle (5.25 – 5.55):                $43                         Level 4/5 (4.45 – 5.15):                                $50
Salamander (11.00 – 11.30):              $43                         Level 8/9/10 (4.00 - 4.45):                             $81
Sunfish (6.00 – 6.30):                   $43

Total: $ _________________________                                 Date & time received:
                                                                             (for Administration use only)
Method of Payment
  Cash     Debit  Cheque (Please make all cheques payable to the City of Weyburn)

Registration - Begins Friday, December 17th @ 5:00 pm at the Weyburn Leisure Centre (532 5                            th
                                                                                                                           Street NE)

    Registrations are on a FIRST COME, FIRST SERVED basis (in person or by mail only; ABSOLUTELY NO PHONE registrations). Mail in
    registrations will only be accepted between December 13th and 16th.

    Refunds will only be given if the cancellation is made AT LEAST 1 week prior to the first lesson. Once the class has started, refunds will ONLY be
    given with a Doctor’s Note. Refunds are subject to a $5.50 Administration fee.

    Weyburn Leisure Services reserves the right to make schedule changes or cancel programs due to insufficient registration.

            For more information, contact Tina Clay, Program Coordinator, by phone at (306) 848-3281, or by email at tclay@weyburn.ca.

				
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