Swim Program Registration Form

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Swim Program Registration Form

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Child Information

NOTE: Please complete one form per child.

Childs Name:

Childs Age:

Last Swimming Level completed (or description if ability of level is unknown)

Parent / Guardian Information

Name (s)

Home Phone:

Work / Cell Phone:

Home Address

Emergency Contact Information

Name(s)

Home Phone

Work / Cell Phone

Additional Information

What swim session are you registering for?

What location are you registering for?

Is the child a resident of Madawaska Valley Township?

YES NO

Are you registering for group or private lessons?

Group Lessons Private Lessons

In the space below, please provide any additional information you deem important (scheduling concerns, allergies, special needs)
Note: that scheduling info is used for development of a schedule and is not a guarantee your request will be fulfilled.

Swim Program Fees

Depending on your selection above the fee varies and is subject to change. Please have a look at our fees PDF document for more information. Payments can be made by E-transfer to payments@madawaskavalley.ca or in person at the Township office by debit, cash or cheque.

How will you be paying?

E-transfer Cash, Debit or Cheque (at the Township office)

Jumpstart Funding

I am self-identifying as having a financial barrier to my child participating in the Swim Program and am requesting Jumpstart funding to cover the cost of a single swim session. I understand I may not be selected for funding, and will be given the opportunity to withdraw my application if this is the case. I do not need to pay for the program until I hear the result of my funding request.

Parent/Guardian Acceptance

I/we understand the inherent risk of injury involved in participation in this swimming program and verify that I will not hold the Township of Madawaska Valley responsible for any loss or injury.

Note: Payment must be received in full by the first day of lessons. Program participation will not be allowed until appropriate forms and payment have been received,. No refunds will be given following the second class of each session.