2023 Swim Lesson Registration 2023 Swim Lesson Registration Family InformationParent/Guardian's Name* Primary Contact Phone* Additional Parent/Gaurdian's Name Additional Contact Phone Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Residential Status*Please Choose...Resident of MonticelloNot a Resident of MonticelloA resident is any individual who resides within the village limits AND pays Monticello taxes. All other individuals living outside the village limits are considered non-residents with taxes being paid to the township.Do you have a pool pass?*Please Choose...YesNoGroup Swim LessonsRed Cross Swim Lessons (With Pool Pass)Please Choose...1st Group (10:15-10:45) Red Cross Swim Lessons (Session 1) $30.002nd Group (10:45-11:15) Red Cross Swim Lessons (Session 1) $30.001st Group (10:15-10:45) Red Cross Swim Lessons (Session 2) $30.002nd Group (10:45-11:15) Red Cross Swim Lessons (Session 2) $30.001st Group (10:15-10:45) Red Cross Swim Lessons (Session 1 & 2) $60.002nd Group (10:45-11:15) Red Cross Swim Lessons (Session 1 & 2) $60.00Parent/Tot (5:30-6:00) Red Cross Swim Lessons (Session 1) $30.00Parent/Tot (5:30-6:00) Red Cross Swim Lessons (Session 2) $30.00Parent/Tot (5:30-6:00) Red Cross Swim Lessons (Session 1 & 2) $60.00Number of ParticipantsPlease enter a number from 1 to 7.1st Participant's Name 2nd Participant's Name 3rd Participant's Name 4th Participant's Name 5th Participant's Name 6th Participant's Name 7th Participant's Name Red Cross Swim Lessons (With Out Pool Pass)Please Choose...1st Group (10:15-10:45) Red Cross Swim Lessons (Session 1) $40.002nd Group (10:45-11:15) Red Cross Swim Lessons (Session 1) $40.001st Group (10:15-10:45) Red Cross Swim Lessons (Session 2) $40.002nd Group (10:45-11:15) Red Cross Swim Lessons (Session 2) $40.001st Group (10:15-10:45) Red Cross Swim Lessons (Session 1 & 2) $80.002nd Group (10:45-11:15) Red Cross Swim Lessons (Session 1 & 2) $80.00Parent/Tot (5:30-6:00) Red Cross Swim Lessons (Session 1) $40.00Parent/Tot (5:30-6:00) Red Cross Swim Lessons (Session 2) $40.00Parent/Tot (5:30-6:00) Red Cross Swim Lessons (Session 1 & 2) $80.00Number of ParticipantsPlease enter a number from 1 to 7.1st Participant's Name 2nd Participant's Name 3rd Participant's Name 4th Participant's Name 5th Participant's Name 6th Participant's Name 7th Participant's Name Private Swim LessonsPrivate Swim Lesson (Resident)Please Choose...Red Cross Private Swim Lesson (½ hr. lesson) $20Number of ParticipantsPlease enter a number from 1 to 7.1st Participant's Name 2nd Participant's Name 3rd Participant's Name 4th Participant's Name 5th Participant's Name 6th Participant's Name 7th Participant's Name Private Swim Lesson (Non-Resident)Please Choose...Red Cross Private Swim Lesson (½ hr. lesson) $25Number of ParticipantsPlease enter a number from 1 to 7.1st Participant's Name 2nd Participant's Name 3rd Participant's Name 4th Participant's Name 5th Participant's Name 6th Participant's Name 7th Participant's Name Terms and ConditionsPlease be aware the Recreation programs involve an element of risk or danger for all participants and may cause serious injury or property loss. The Recreation Department does not provide nor cover any medical or hospital insurance for participants in our program. Anyone participating in sponsored programs assumes risk of all injuries. In order to participate, an adult signature is REQUIRED. I have read and agree to the terms above* Check box for signature Total Pool FeesTotal $0.00 Registration SubmissionCaptchaPhoneThis field is for validation purposes and should be left unchanged.
