Registration  Form  on  Back    

 

Coached by Southwestern Swimming’s Coaching Staff & Collegiate Athletes!

Who: Grades 1-12 (children must be water safe)

When: Saturdays in October @ Mingus Park Pool

Advanced Clinic: Stroke, Starts, & Turns Technique, and Intro to Dryland Strength and Conditioning

Time: 12:45-3pm Cost: $25 for 1 day / $75 for all 5 Saturdays

Beginner Clinic: Begin to Learn 4 Competitive Strokes Time: 1:45-3pm Cost: $20 for 1 day / $60 for all 5 Saturdays

**Family  discount  –  25%  OFF  each  additional  sibling**  

   

 

 

 

 

SWOCC  SWIM  CAMP  REGISTRATION  FORM  –    Return  to:  Sandra  Bullock,  Southwestern  Oregon  Community  College,  1988  Newmark  Ave.,  Coos  Bay,  OR  97420.      

Please  make  checks  payable  to:  Southwestern  Oregon  Community  College  Swimming  

Camper’s  Name  _________________________    

Parent’s  Name(s)___________    ____________________   ______    

Address  ____________________________________        

City,  State,  Zip      ______________________________          _____  

Phone  _____________________            __________   _          ___  

Emergency  Phone  _______________________________        ___    __    

Email__________________________________________        _  ____  

�  Male  

�  Female  

Age  ______  

Grade  in  the  Fall  _________  

 

DAY  CAMPER  FEE  

ADVANCED  CLINIC    

� One-­‐time  Fee:$25      Date:      

� Additional  Siblings:  $18.75    

� 5-­‐Saturdays  Fee:  $75  

� Additional  Siblings:  $56.25    

 

BEGINNER  CLINIC    

� One-­‐time  Fee:  $20    Date:      

� Additional  Siblings:  $15    

� 5-­‐Saturdays  Fee:  $60  

� Additional  Siblings:  $45    

T-­‐SHIRT  SIZE:  Youth:    �  S        �M        �L            �XL   Adult:    �S        �M   �L        �XL        �XXL    

I  acknowledge  that  I  have  elected  to  have  my  son/daughter  participate  in  an  activity  that  includes  some  risk  of  injury  to  him/her.  I  hereby  release  EPUERTO  Sports  and  Southwestern  Oregon  Community  College,  its  employees  and  agents  from  any  injury  or  damage  my  son/daughter  may  suffer  as  a  result  of  my  voluntary  participation  in  this  activity  and  I  hereby  hold  harmless  Southwestern  Oregon  Community  College,  it’s  employees  and  agents  from  any  and  all  liability  as  a  result  of  any  injury  or  damage,  of  whatever  nature,  my  son/daughter  may  suffer  as  a  result  of  their  voluntary  participation  in  this  activity.    

Parent’s  Signature___________________________________________________    Date  _____________    

 

Southwestern  Oregon  Community  College  is  an  equal  opportunity  educator  and  employer.