BSTR

BUILDING SKILLS THROUGH RECREATION

AQUATIC REGISTRATION FORM

Application and Student Profile
2023 – 2024
Please print clearly

First & Last Name: ___________________________________________________________________

Date of Birth: (mm/dd/yy) ___________________________________________________________

Phone number: _____________________________________________________________________

Home Address: _____________________________________________________________________

Email Address: ______________________________________________________________________

 I will be 15 years old by October 23, 2023

Aquatics: (Mark (X) which program choice and circle correct location)

Complete INST Stream (please check one): Aquatic Fitness Stream

Bronze Medallion/Cross, NL, Instructors, SFA/C
Aquatic Fitness Certificate, SFA/C
 CW Jeffreys  St. Lawrence CRC
OR
 West Hill  Mary McCormick CRC

Pool Attendant Stream (please check one):

Pool Attendant Certificate, SFA/C

 Jimmie Simpson  Pam McConnell  Albion Pool

 JJP  Wellesley CRC

Registration Information
Please fill out the attached registration form and email or scan it to:
Adriana.Pires@toronto.ca

Signature: Date:__________________________

By submitting this form, you are registered for the program you selected above, pending the completion of any screenings required.
You will be contacted if there are any changes or if the program you registered for is full.

Please note that for some of the programs, you may not be contacted until a few weeks before the program begins.