Registration Form

SACS NATATORIUM REGISTRATION FORM-- Please fill out this form mail your payment to:
Summit Middle School
4509 Homestead Rd.
Fort Wayne, IN 46814
Attention: Liz Story for Summer Swim Lessons
Fee: $60 -made out to Summit Middle School

Please use only one registration form per participant.
Name of Class Participant:________________________________Age:_____________
School Attending:______________________________ Grade in Fall 2016:___________
Parents Name(s):__________________________________________________________
Address:_________________________________________________________________

City:__________________________________ State: _____________ Zip:___________
Contact Phone #:__________________________________________________________

Contact Email Address:_____________________________________________________
Session #:____________________ Class Name and Time:________________________
Emergency Contact Name:________________________ Phone Number:____________