Jane Whitt Swim School

Fall/Winter Enrollment

Student Name:

Address:

City:                                                  State:                       Zip:                                 

Daytime Phone:                                     Home Phone:                    

Birthdate:                                                 *Email:                  

Parent/Guardian Name:
                                                           

 

Choose from the following:  (check all that apply)

     ___  Fall Session - Wednesdays, September 19 - October 10, 2012

       ___  Winter Session -  Wednesdays, February 6 - 27, 2013

      ___  Both Sessions

    ___  I will need classes 5:30 or later

          (NOTE:  Level IV and V class will be 7:00 pm or later)

Please enclose a fee of $50.00 per single session   or   $90.00 for both fall and winter with your enrollment form and mail to:

Jane Whitt Swim School
7030 South Lewis, Suite J
Tulsa, OK 74136