Baylor Tom Landry Fitness Center: Fish Factory Registration Form

Please print off, type in required information, and return with payment to: Baylor Tom Landry Fitness Center Attn: Accounting 411 N Washington, Suite 1900 Dallas, TX 75246

Participant Name:		________________________________________
Gender:		________________________________________
Age:		________________________________________
Date of Birth:		________________________________________
Address:		________________________________________
City:		________________________________________
State:		________________________________________
Zip:		________________________________________
Parent Name:		________________________________________
Area Code & Phone:		________________________________________
Email:		________________________________________
How did you hear about our program?		________________________________________

I am the parent or legal guardian of ______________________________ who is participating in Fish Factory Swim School. I waive all claims against the Baylor Tom Landry Fitness Center, the Baylor Health Care System and any of its affiliates, including all employees of such entities. My child has no current health problems that would prevent him/her from participating fully in this program. I hereby give consent for my child to be medically treated for injury or illness if the need arises while he/she is attending swimming lessons.

2008 Fall Session:
	Session 1: T–TH — Sept 9 ^th– Oct 2^nd

Time: Select one
	4:15 – 4:45 p.m.		5:00 – 5:30 p.m.

Swimming classification (check one)
My child...
____	will not put his/her face in the water.
____	will put his/her face in the water, but can not get to the side independently.
____	can get to the side, but method is rough.
____	needs stroke improvement.



_______________________________________________________
Signature of Parent and Date

Class Fee: $120/child/session

If you have questions please contact: Monica Palmer Aquatics Baylor Tom Landry Fitness Center (214) 820-8922 monicapa@baylorhealth.edu