including the Parks' Facebook page. In the event I or my child is injured and I cannot be reached to make emergency medi
Mondays and Wednesdays Session 1: June 5-28 & Session 2: July 10-August 2 Tuesdays and Thursdays Session 1: June 6-29 & Session 2: July 11-August 3 Cost: $40 Resident (Edwardsville or Glen Carbon) or $50 Non-Resident Class options*: Parent Tot: 9:30am-10:05am or 10:15am-10:50am Starfish (Level 1): 9:30am-10:05am, 10:15am-10:50am, or 11:00am-11:40am Clownfish (Level 2): 9:30am-10:05am or 11:00am-11:40am Sea Turtles (Level 3): 10:15am-10:50am Sword Fish (Level 4): 11:00am-11:40am *See next page for more information Class:___________________________Days:___________________________ Time:______________________ Session:______ Child’s Name:____________________________________________________ Child’s Age:_________ Parent’s Name:___________________________________________________ Address:________________________________________________________ City, State and Zip_________________________________________________ Phone:____________________________________________ Email Address:________________________________________________ Pool House 618-444-4637
SIUE Campus @ Lot 10: 88 Recreation Dr. Edwardsville, IL
Minor Release Form I and the above stated child is permitted to participate in the Edwardsville Parks and Recreation Department’s swimming lessons at the Edwardsville Glen Carbon Community Pool. I do understand that insurance is not provided and that the City of Edwardsville, Edwardsville Parks and Recreation Department, Edwardsville Glen Carbon Community Pool, and any other personnel involved with this program are not responsible for any injuries or accidents that may occur before, during or after any activities. I hereby give permission for my child to engage in Edwardsville Parks & Recreation activities. I also agree to allow both my image and my child’s image to be used in Edwardsville Parks & Recreation program guides and brochures, including the Parks’ Facebook page. In the event I or my child is injured and I cannot be reached to make emergency medical arrangements or circumstances make it impracticable for me to be reached, I hereby authorize a Parks and Recreation Department employee to contact emergency medical personnel. I covenant and agree, that for and in consideration of my participation and my child’s participation in such activities, to indemnify and hold harmless the City of Edwardsville, its employees, agents, sponsors and volunteers assisting in these activities, from any and all damages, claims or liability of any kind, whatsoever, by reason of injury to property or third persons occasioned by any error, omission or negligent act of myself or my child. I further do hereby expressly release, discharge and hold harmless the City of Edwardsville, its employees, agents, sponsors, and volunteers assisting in these activities, from any and all damages, claims, or liability of any kind, whatsoever, from any injury or death to myself or my child or damage to property, arising or resulting from my participation or my child’s participation in these activities or transporting myself or my child to and from such activities. This waiver of liability does not apply to any acts of gross negligence, or intentional, willful, or wanton misconduct of the Department or the City. I hereby give permission for my photograph or my child’s photograph to be used in printed publications for the City of Edwardsville Parks and Recreation Department.
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Child’s Name (Printed)
Parent’s Name (Printed)
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Date
Parents’ Signature
Emergency Information: Emergency Contact:__________________________ Phone Number:___________________ ___ Mail to Edwardsville Parks , Attention: Swim Lessons, 118 Hillsboro Ave. Edwardsville, IL 62025 Make checks payable to Edwardsville Office Use Only: Amount:______ Check, Cash, Credit Card:____________
Pool House 618-444-4637
Date:_________ Staff:___________________
SIUE Campus @ Lot 10: 88 Recreation Dr. Edwardsville, IL
Mondays and Wednesdays Session 1: June 5-28 & Session 2: July 10-August 2 Tuesdays and Thursdays Session 1: June 6-29 & Session 2: July 11-August 3 Cost: $40 Resident (Edwardsville or Glen Carbon) or $50 Non-Resident Class options: Parent Tot: 9:30am-10:05am or 10:15am-10:50am Designed for children ages 3 and under, this level gets the parents involved. The focus is to get the children comfortable with the water with help and support from their parents. A parent must be in the water with the child Starfish (Level 1): 9:30am-10:05am, 10:15am-10:50am, or 11:00am-11:40am Designed for children ages 3-6 and get children comfortable in the water away from their parents. Children will learn the basics of going under water, floating, and leg/arm actions that they will incorporate in futures levels. Most skills are done with support by instructor or flotation device. Clownfish (Level 2): 9:30am-10:05am or 11:00am-11:40am Now you can start to really have fun by learning to swim on your own. This class is designed to slowly get rid of support and teach you to be more independent in the water by swimming on your own. For ages 10 and under. Sea Turtles (Level 3): 10:15am-10:50am Your swimming all by yourself now but practice makes perfect. This class will focus on refining the stroke you have already learned so you can swim farther. Skills will also include intro to treading and retrieving object in deep water. For ages 10 and under. Sword Fish (Level 4): 11:00am-11:40am You are a lean, mean, swimming machine and now and nothing can stop you. So pull out your sword and get ready to fight that water and swim farther. During this class we will focus on refining your stroke. Skill will also include surface dives, treading, swimming underwater. For ages 10 and under. Pool House 618-444-4637
SIUE Campus @ Lot 10: 88 Recreation Dr. Edwardsville, IL
