2013 Aquatics Program Enrollment Form Thank you for your interest in the Chapel Hill Country Club Aquatics Program. Please Review the rest of the brochure for program details and cost information. Each child must be enrolled using a separate form. Please submit to the Chapel Hill Country Club Business Office. All spaces will fill on a first‐come and first‐serve basis.
Please enroll me in: Pre‐Season Clinic Group Lessons; Session Preferences:__________________________________ Private Lessons; Desired days and time_______________________________ Masters Program Name of Participant:________________________________________________________________________ Parent/Guardian Name:____________________________________________________________________ Address:______________________________________________________________________________________ ________________________________________________________________________________________________ Home Phone:_______________________________Parent Cell:____________________________________ Email:__________________________________________Participant’s Birthday:_____/_____/______ Most Recent Swim Level*:_________________________________________________________________ Level 1: Blowing Bubbles. Level 2: Front and Back Floats. Level 3: Front and Back Kicks. Level 4: Freestyle arms with kicking. Level 5: Freestyle with side breathing. Level 6: Backstroke arms with kicking. Level 7: Butterfly, Breaststroke, and flip turns. Total Cost:______________________ Circle: CASH CHECK *Please make checks payable to the Chapel Hill Country Club Aquatics Director, Jesse Mendes. *You will only be contacted if we need to make a change to your requested class times. If you do not hear from us, assume your time and date request was accepted. Please make a note of the dates and times of classes. **In the case of inclement weather, make‐up classes will be scheduled. Questions? Contact: Jesse Mendes OR Chapel Hill Country Club Aquatics Director 103 Lancaster Drive email@example.com Chapel Hill, NC 27517 (919) 967‐8201