“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: ___________________________________________________________
(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”