2008 American Red Cross Summer Swim Program

Callaway Chapter - OESTREICH POOL - Fulton, MO

Swimmer’s Name: ____________________________________ Birthdate: ______________

Age: ________ Parent’s Name: _________________________________________________

Address: _______________________________________ City/Zip Code: _______________

Home Phone #: ___________________________ Work Phone #: _____________________

E-Mail: ____________________________________________________________________

Emergency Contact: __________________________________ ph #: __________________

FEES: There is a $25.00 fee per student for the first two children in each family; a $20.00 fee for any additional children in a family.  All classes will be given under the direction of certified Red Cross Water Safety Instructors. NO CHILD WILL BE DEPRIVED LESSONS BECAUSE OF THE INABILITY TO PAY.

PLEASE CHECK THE CLASS YOU WISH YOUR CHILD TO ATTEND

SESSION I - July 14- July 25              Monday – Friday              SESSION II - July 28- Aug. 8

____ Level VI Personal Water Safety &/or                       ____ Level VI Personal Water Safety &/or

        Lifeguard readiness 8-9 am                                         Lifeguard Readiness 8-9am

____ Level V 8:00 - 9:00 am                                                ____ Level V 8:00 – 9:00 am

____ Level IV 9:00 – 9:45 am                                               ____ Level IV 9:00 – 9:45 am

____ Level III 10:00 - 10:30 am                                            ____ Level III 10:00 – 10:30 am

____ Level III 10:30 – 11:00 am                                  ____ Level I & ___ Level II 10:30 – 11:00 am

____ Level I & ___ Level II  11:00 - 11:30 am               ____ Level I & ___ Level II 11:00 – 11:30 am

____ Level I & ___ Level II  11:30 - 12:00 noon             ____ Preschool 11:30 – 12:00 noon

                   Evening Classes         Monday-Thursday                  Evening Classes

____ Preschool 7:00 - 7:30 pm                                    ____ Preschool 7:00 - 7:30 pm

____ Level I & ___ Level II  7:30 - 8:00 pm                   ____ Level I & ___ Level II  7:30 - 8:00 pm

____ Level I & ___ Level II  8:00-8:30 pm           ____ Level I & ___ Level II  8:00 – 8:30 pm

____ Level III  8:30 – 9:00 pm                                    ____ Level III  8:30 – 9:00 pm

____ Level IV  8:30 – 9:00 pm                                    ____ Level IV  8:30 – 9:00 pm

WAIVER   OF   LIABILITY

I give permission for _________________________ to participate in the Summer Swim Program of the Callaway Chapter of the American Red Cross.

I, the parent/guardians of the above named student, understand that participation in this activity is potentially hazardous. I certify that this student is physically qualified to take group-swimming instruction and participate in this activity.

I hereby agree to abide by the rules and regulations governing this activity and elect to have the above name student participate at their own risk, and discharge the City of Fulton, the American National Red Cross, their assignees, officers, agents, employees, volunteers and officials and their successors from any and all liability (including death) that may be received by the above named student and from all claims and demands to personal property resulting from the student’s participation and/or arising out of travel to and return from Red Cross Summer Swim Lessons conducted by the Callaway Chapter of the American Red Cross at the Oestreich Pool in Fulton, Mo.

I grant full Permission to the sponsors, organizers and affiliated to use this student’s name, photographs or any other record of participation in this event for picture in any broadcast, telecast, or any other written account of the event fro publicity purposes, without compensation or remuneration.

____________________________ (parent/legal guardian Signature) Date:_____________