SAFETY AROUND WATER REGISTRATION FORM

Registration forms may be mailed or brought into the YMCA of Darke County.
Please call to confirm receipt of registration form. SAFETY AROUND WATER
Please PRINT and please fill out one form PER child.
ALL FIELDS MUST BE COMPLETED IN ORDER TO PROCESS THE REGISTRATION. SWIM SAFELY WITH
Parent/Guardian Name ______________________________________________________________
Address _______________________________________ Primary Phone _____________________
City, State, Zip _______________________________ Email ________________________________
Parent/Guardian Birthdate _________________
Emergency Phone__________________
Childs Name ___________________________________
Childs Birthdate _____________________________ School ______________________________
First-time attendee? Yes No
Current Swimming Ability (check one)
Nonswimmer Beginner Advanced YMCA OF DARKE COUNTY
Class offerings for grades K-6 and ages 3-5. Class Time Desired:

May 30 - June 1 at Versailles Branch June 19 - 21 at Greenville Branch

VE Branch - May 30 - June 1
9:00 - 9:45 AM 9:00 - 9:45 AM
9:45- 10:30 AM
4:00 - 4:45 PM
9:45 - 10:30 AM
10:30 - 11:15 AM Parent & Child*
GV Branch - June 19 - 21
4:45 - 5:30 PM 2:00 - 2:45 PM
5:30 - 6:15 PM 2:45 - 3:30 PM
6:15 - 7:00 PM Parent & Child* 3:30 - 4:15 PM SPONSORED BY:
6:00 - 6:45 PM Parent & Child*
6:45 - 7:30 PM
7:30 - 8:15 PM

*(Parent & Child Class: Child must be 3-5 years old, not completed Kindergarten,
and parent must get in water with child.)
Langston Graphics, Inc.

Has your child participated in a YMCA Program before? Yes No

Are you interested in helping as a volunteer? Yes No
My child is in good health and may participate. This event is complimentary to all participants grades K-6 and ages 3-5.
ADVANCED REGISTRATION REQUIRED
Parent/Guardian Signature Date
 SAFETY AROUND WATER
Swim Safely With:
MAKE A SPLASH!
A fun way for kids to learn CLASS CURRICULUM
how to be safer around water! Pool Safety
Backyard Pool Safety
Boating Safety
VE Branch - May 30 - June 1 Beach Safety
Basic Swimming Skills
GV Branch - June 19 - 21 Basic Rescue Skills

YMCA OF DARKE COUNTY 45 Minute classes offered on specified dates

Greenville Branch Versailles Branch No charge to the participant or the participants family
301 Wagner Avenue 10242 Versailles-SE Road
Greenville, OH 45331
Advanced registration required
Versailles, OH 45380
Certificate of completion

Sponsored By:

Langston Graphics, Inc.