Exit this survey

2017 Shelbert Swim Academy Instructors Rehire Form

This information must be submitted by December 5, 2016. If you have any questions, please contact Hope Walker at 815-520-9865 or HopeWalker@rockfordparkdistrict.org

Question Title

* 1. Please enter the information indicated below:

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:

Last Name:

Email Address:

Zip Code:

Home Phone:

Cell Phone:

Question Title

* 2. Date of Birth:

Date:

Date

Question Title

* 3. Choose location(s) that you will be working:

Alpine Pool

Sand Park Pool

Question Title

* 4. Uniform Information
It is very important that you submit a swimsuit size. If you are not sure of your size, go to Runner's Image to determine correct size. Suit sizes are submitted to Runners Image in February and no additional swimsuit orders can be placed after that order. Please indicate the swimsuit size that you wear below:

Female 28

Female 30

Female 32

Female 34

Female 36

Female 38

Female 40

Female 42

Male S

Male M

Male L

Male XL

Male XXL

Question Title

* Rashguard Size

S

M

L

XL

XXL

Thank you for completing the Learn to Swim Information.