Name ___________________________ Sex _______ Address ________________________________

Age ______ Grade ______ Home Phone # _______________ Emergency Phone # ________________

SWIM INSTRUCTION:  All lessons are $50.00 for children who are not attending Summer Magic Day Camp.

Saturdays                                            4th & 5^th and 6th  grade        (9:00 - 9:30 AM)   _____
  For 6 wks.                                           2^nd &  3^rd grade                     (9:30 -10:00 AM)  _____
                                                             4 & 5 years 1^st grade        (10:00 - 10:30 AM)  _____

OTHER PROGRAMS:

End of Season Lessons                ______ ($50.00)
Parents/Tots Lessons                   ______ ($50.00)         
Swim Instruction for the disabled  ______ ($30.00)

 

As a participant in the above program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risks of any injuries, damages or loss which I or my child may sustain as a result of such participation. I further understand that the Village of Dobbs Ferry does not provide accidental medical coverage and it is my responsibility to provide appropriate coverage. I agree to waive and relinquish all claims and hold harmless the Village of Dobbs Ferry, Parks and Recreation Department, its officers, agents and employees from any and all claims.

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