Washington Township Recreation Center Waiting List

Survey - Please Check:
Resident Complete Pass Holder
Resident
Non-Resident Complete Pass Holder
Non-Resident

1.  Class Name:

2.  Child's Name:      Birth Date:     /     /    
                                                                                                             (MM /   DD /    YYYY)

            Male  Female         Grade as of Fall 2009:

3.  Parent/Guardian Name:
    Parent/Guardian Email:

4.  Phone Numbers
(Please put phone numbers in order that you want to be called and what they are - home, cell, work, other.)

    Phone Number 1: ()  

    Phone Number 2: ()  

    Phone Number 3: ()  

    Phone Number 4: ()  

5.  Availability for classes - does registration depend on another sibling - Yes  No
                                                                                         If "Yes", what level:
                                                                                        You will only be called if both classes are available.

    Availability (Please check all that apply):

Fall Swim Sessions Only  AM  PM Any Time
AM or PM
Session 1: 1/11 - 3/15 (Mondays)
Session 2: 1/12 - 3/16(Tuesdays)
Session 3: 1/13 - 3/17 (Wednesdays)
Session 4: 1/14 - 3/18 (Thursdays)
Session 5: 1/16 - 3/27 (no class February 13) (Saturdays)

6.  You are requesting a transfer ($10.00) -- please complete:

     CURRENT Class Name:     Class Number:


I have received waiting list policy.  I must return call within 4 hours to be eligible for
a spot (messages count!).  To be enrolled in class I must pay in FULL within 24 hours.