Swim Lottery Form

To maximize your chances for enrollment, please select at least three class choices. All forms must be submitted by 8:00pm on Sunday, August 24, 2014.  Lottery Results will be posted online after 5:00pm on Wednesday, August 27, 2014. Results will be posted under participant’s first name, last initial and last four digits of phone number.

Group Swim Lesson Schedule FA14 – Sept 8 – Nov 2

Parent Name *

First

Parent Last Name *

Last

Phone Number

Email Address *

Are there any medical or other circumstances we should be made aware of?

Participant #1

Name *

Birthdate *

First Choice - NOTE: All classes meet once a week. *

Second Choice *

Third Choice *

Participant #2

Name

Birthdate

First Choice

Second Choice

Third Choice

Participant #3

Name

Birthdate

First Choice

Second Choice

Third Choice

Participant #4

Name

Birthdate

First Choice

Second Choice

Third Choice

Participant #5

Name

Birthdate

First Choice

Second Choice

Third Choice

HR

---

Please include additional comments here

(ie - more class choices)

Survey

Please rate the following regarding your experience with the online lottery form process

Convenience

Very Satisfied

Satisfied

Unsatisfied

Very Unsatisfied

User Friendliness

Very Satisfied

Satisfied

Unsatisfied

Very Unsatisfied

If you are human, leave this field blank.