FINS Summer Swim Program

Swimming applications2018

“Have fun in the water by SWIMMING SAFELY”

This program is for youth ages 4 – 16 years of age and is being offered to Barnwell County youth in the towns of Barnwell and Blackville/Williston. You will be contacted by phone or letter regarding the time and place the swimming lessons will be offered.

*Application Deadline: June 8, 2018 *Transportation will not be provided.

Name of Child: _____________________________________________________________

Age of Child: ________________ Date of Birth: _____________________________

Has child had swimming lessons before? ____yes ____no

If yes, how many years has your child had lessons? ______

Name of Parent / Guardian: ___________________________________________________

Mailing Address: ___________________________________________________________

___________________________________________________________________

Phone: ____________________________________________________________________
(please leave a number you can be reached to schedule to lessons)

Please check the best week: _____Barnwell Pool Dates: June 11-14 _____ June 18-21 _____
_____Blackville Pool Dates: TBA
*Lessons in Barnwell are at 9:00, 10:00, or 11:00 and lessons in Blackville TBA (to be announced) **Children are scheduled according to their ages

I give my child permission to participate in the FINS swimming program. I will not hold the Barnwell Rotary Club, AXIS I Center of Barnwell, or owners of the swimming pool facilities liable for any accidents, injury, loss, or damage. I understand that each pool will have a swimming instructor and lifeguard present at all times.

Signature of Parent /Guardian: ______________________________ Date: _______________

Emergency Contact Name: __________________________________

Phone Number: _______________________

Family Physician: ________________________________ Phone: __________________

Insurance Carrier: _____________________________ Number: _______________________

Medical Conditions: ___________________________________________________________

Please return this form to: AXIS I CENTER OF BARNWELL, 1644 Jackson Street, Barnwell, SC 29812.
Attn: Kathy Fox (If you have any questions, please call 541-1245 and someone will assist you)

This is a free program sponsored by the Barnwell Rotary Club and AXIS I Center of Barnwell
.
“IN LOVING MEMORY OF B.B. BAXLEY”