TOWN OF LAFAYETTE SWIM REGISTRATION
IN CONJUNCTION WITH THE TOWN OF POMPEY - SUMMER 2016
The Town of Pompey’s summer swim program is being offered to include the Town of LaFayette at the Cazenovia College Natatorium. Classes are held every morning, Monday-Friday.
The LaFayette children lesson time is from 11:15am – 12:00noon. Parents must supply all transportation.
DEADLINE FOR REGISTRATION IS May 23, 2016.
All are 45-minute classes held July 5 – July 22
Level I Fear of water, age 4+ Level VI Swimming & Skill Proficiency
Level II Fundamental Aquatic Skills, age 5+
Level III Stroke Development
Level IV Stroke Improvement Personal Water Safety (age 11+)
Level V Stroke Refinement WSIA- (Water Safety Instructor Aide)
Child’s name and AGE Swim level successfully completed
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In an emergency, when the undersigned person cannot be reasonably contacted, I hereby authorize Town of Pompey and/or Town of LaFayette to take any action which it deems necessary to protect the best interest of my child. I understand that Town of Pompey and/or Town of LaFayette does not carry insurance coverage on swim program participants and that it is my responsibility to provide such coverage for my child. I acknowledge that the Town of Pompey and/or Town of LaFayette is not a guarantor of my child(s) safety and agree to defend, indemnify and hold harmless the Town of Pompey and/or Town of LaFayette against all claims, judgments, actions or other liabilities for both property damage and bodily injury in any way whatsoever incurred through my child(s) participation in this program.
Signature of parent/guardian X ________________________________________________________
Parent’s name/address/phone
Emergency contact/address/phone (include relationship)
Mail to: LCC, PO Box 98, LaFayette, NY 13084
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