PARC Swim Waitlist

Please complete this form to be placed on our PARC Swim waitlist.

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* 1. Parent's full name

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* 2. Parent's phone number

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* 3. Parent's email

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* 4. If a place becomes available, we will attempt to contact you by phone. When is the best time for us to contact you by phone?

	9am - 11am	11am - 1pm	1pm - 3pm	3pm - 5pm	Not available
Mon - Fri	Mon - Fri 9am - 11am	Mon - Fri 11am - 1pm	Mon - Fri 1pm - 3pm	Mon - Fri 3pm - 5pm	Mon - Fri Not available
Sat - Sun	Sat - Sun 9am - 11am	Sat - Sun 11am - 1pm	Sat - Sun 1pm - 3pm	Sat - Sun 3pm - 5pm	Sat - Sun Not available

Comments

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* 5. Children's full names

Child 1

Child 2

Child 3

Child 4

Child 5

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* 6. Children's dates of birth

Child 1 - DOB

Child 2 - DOB

Child 3 - DOB

Child 4 - DOB

Child 5 - DOB

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* 7. Description of ability for each child

Child 1

Child 2

Child 3

Child 4

Child 5

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* 8. Details of previous lessons for each child

Child 1

Child 2

Child 3

Child 4

Child 5

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* 9. Are there any special needs or special requirements that we need to be aware of? Please indicate each child's name and describe their requirements.

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* 10. Do you have any other children currently enrolled in PARC Swim?

Yes

No