Parent and Child Swim Lessons Sign Up Form

All sign ups must be received before the start of the session. All sessions must have at least 2 students to be held. If the class does not have enough students we will contact you.

If you have any questions please email Robin Loft at rloft@kirksvillecity.com

All Fields are REQUIRED. An email confirmation will be sent once your sign up is received.

Please supply the following information:

Child's Name
Age
Parent's Name
Street Address
City
Zip Code
Daytime Phone Number
Evening Phone Number
Email

Please select which session you are signing up for.

Beginners	Advanced
Monday and Wednesday: 5:30-6pm	Tuesday and Thursday: 5:60-6pm
December 1st-December 17th	December 2nd-December 18th
January 19th-February 4th	January 20th-February 5th
February 16th-March 4th	February 17th-March 5th
March 16th-April 1st	March 17th-April 2nd
April 6th-April 22nd	April 7th-April 23rd

Please use the space below to supply additional comments:

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