Greater Newark Boys and Girls Club
1 Positive Place
Newark, DE 19702
302-836-6464
www.swimattheclub.org
Summer 2017 Swim Lesson Registration Form
Please Check Session/s and Time you are registering for
 Beginner  Intermediate  Parent Tot  Adult
Time
Beginner
 5:00
 5:30
 6:00
 6:30
Parent Tot
 6:00 Tue
Monday:
Intermediate
 5:00 Tue
 5:30 Tue
 6:00 Mon/Thu
 6:30 Mon/Thu
Adult
 9am Tue
 6:30 Tue
 Summer A 6/5-6/26
 Summer B 7/10- 7/24 Mini
 Summer C 7/31-8/21
Thursday:
 Summer A 6/8-6/29
 Summer B 7/13-7/27 Mini
 Summer C 8/3-8/24
(One Swimmer per form) Please fill
*Swimmer First and Last Name:
Nickname:
Membership Expiration: ______
Tuesday:
Price per Session
 Summer A 6/6-6/27
 Summer B 7/11-7/25 Mini
 Summer C 8/1-8/22

Wait List:
 Summer A
 Summer B
 Summer C
Preferred Day/Times:
Day _____ Time_____
Day _____ Time_____
Full 4 Week Session $44
Discount: 2nd Child $41, 3rd + Child $38
GNBC Child Care $22
3 Week Mini Session $33
Discount: 2nd Child $30, 3rd + Child $27
GNBC Child Care $16.50
in all boxes with an *
*Age
*Street Address:
*Birthdate:
Male or
Female
*Parent/Guardian Name:
*City:
*Day-time Phone:
*Emergency Phone:
*Medical problems/Allergies/Medications:
*State:
*Zip:
School:
*Email:
How did you hear about us?
Website School Library Word of mouth Marquee Other ___________________________
Information:
 Lessons are one lesson per week for either 4 weeks or 3 weeks
 Lessons are 30 Minutes long
 Checks should be made payable to the Greater Newark Boys & Girls Club.
Please check a box for each statement below in reference to your child’s water experience.
My son or daughter…
Always
Some-times
Never
Not Sure
Spends time in a pool regularly.
Puts his/her face all the way under the water.
Is afraid of the water.
Needs help in water that is deep.
Likes to float on his/her back.
Loves to swim.
Can swim with the help of a flotation device.
Can swim all by him/her self.
Can tread water.



I understand that the instructors may be adjusted or changed at any given time.
Class times may be adjusted/changed/cancelled based on enrollment.
There are No Make-up lessons unless the Aquatic Department cancelled the lessons due to weather .

$5.00 fee for cancellation or change in registration
Parent or Guardian Signature _________________________________________________
For Office Use Only.
Date received: __________
Payment Type:__________
Amount received: __________
Balance: _________
------------------------------------------------------------------------------------------Swim Lesson Reminder
Session/s: ________________ Day: ________________ Time: _____________
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
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$5.00 fee for cancellation or change in registration
There are no Make-up lessons unless the Aquatic Department cancelled the lessons due to weather.
Class times and may be adjusted/changed/cancelled based on enrollment