Application — Central Adult Learn-to-Swim, Inc.

Adult Learn-to-Swim Waitlist

To serve as many new swimmers as possible, we ask you to respond to this form to express your interest in the beginner ALTS program. The sooner you respond, the quicker we can plan classes to meet the demand captured in the form.

Completing this form does not guarantee or confirm registration in a class. Registration in a class is only confirmed by a representative from Central Adult Learn-to-Swim, Inc. via phone or email.

Name

First Name

Last Name

Date of Birth

YYYY

Primary Phone

(###)

###

####

Secondary Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Availability - First Preference

Please select your first preference for days and times you are available for a session. Each session is comprised of four classes.

Availability - Second Preference

Please select your second preference for days and times you are available for a session. Each session is comprised of four classes.

Comment

Please tell us anything else we need to know about you.

Acknowledgements

Please put a check in the boxes next to each acknowledgement to confirm your understanding of our policies and procedures.

I understand that a beginner Adult Learn-to-Swim class is a mandatory four part commitment. I will only accept a registration if I can attend 100% of the scheduled program sessions.

I understand that by submitting this form I am not guaranteed to be accepted, do not have a registration for a beginner Adult Learn-to-Swim class, and will not walk in for a pre-registered class.

I understand that I will be contacted by a representative of Central Adult Learn-to-Swim, Inc. by phone or email upon acceptance of this application to discuss registration.