| CITY OF PROSSER, WA |
| RECREATION
PROGRAMS REGISTRATION FORM |
| 601 7TH STREET |
| PROSSER, WA 99350 |
|
509-786-2332 |
|
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| PARTICIPANT'S
NAME_______________________________________________________________________________MALE_______FEMALE_______________ |
| PARENT/GUARDIAN
NAME(PLEASE
PRINT)_______________________________________________________________________________________________ |
| ADDRESS_________________________________________________________CITY_______________________________AGE
AS OF 6/1/06________________ |
| WORK
PHONE_____________________________HOME
PHONE_____________________________OTHER__________________________________________ |
| ANY MEDICAL
PROBLEMS OR
DISABILITIES______________________________________________________________________________________________ |
| DOCTOR'S
NAME______________________________________________________DOCTOR'S
PHONE_______________________________________________ |
| ***CLASSES AND
PRICES ARE SUBJECT TO CHANGE*** |
| SUMMER REC |
|
COMMUNITY SCHOOL CLASSES |
|
SWIM LESSONS |
| Pee
- Wee Ball |
|
|
Body Sculpt |
$ |
|
Level I Minnow(formerly water babies) |
|
boys & girls, ages 5-6 |
|
2days__$30__$75/1day__$20__$60 |
|
Water Adjustment |
| Mini Ball |
|
|
|
Great Games |
$ |
|
Float on back with assistance |
|
boys & girls, ages 7-8 |
|
$30 Session__________ |
|
Float on stomach with
assistance |
| Boys
minor/major baseball |
|
|
Line Dancing |
$ |
|
Jump to instructor-Safety
skills |
| ages 9-12 |
|
|
$30 for complete class |
|
Level II Guppies(formerly
Porpoise) |
| Girls
minor/major softball |
|
|
Tournament Chess |
$ |
|
Stream line kicking(front
& back) |
| ages 9-14 |
|
$20 for complete class |
|
Rhythmic breathing |
| ***We need coaches. Please |
|
Open Gym Basketball |
$ |
|
Glides with flutter kick |
| indicate how you would be |
|
$25
Season Pass___ |
|
Swim 5 yards-Safety
skills |
| interested
in volunteering: |
|
Open Gym Soccer |
$ |
|
Deep water orientation |
| Coach |
|
$15 complete season |
|
Level III Otters(formerly
Pre-Beginner) |
| Assist Coach |
|
Men's Basketball League |
$ |
|
Recover object from
bottom |
| Sponsor |
|
$100 team |
|
Introduction to a variety
of strokes |
| **Notes |
|
Co-Ed Softball |
$ |
|
Introduction to turns |
| |
|
$100 team |
|
Diving - Deep water
bobbing |
| |
|
Basketball Camp |
$ |
|
Rotary Breathing |
| |
|
$55 per person |
|
Level IV
Barracudas(formerly Beginner) |
| Tennis |
|
|
|
Summer Breeze |
$ |
|
Alternate breathing |
| boys & girls, 6-15 |
|
$40 w/pool______$30 no pool______ |
|
Stroke work(crawl, back,
side, etc) |
| Roller
Hockey |
|
|
Yoga |
|
$ |
|
Open turns (front &
back) |
| boys & girls, all ages |
|
$65 for eight week session |
|
Stride jump & Shallow
dive |
| Golf |
|
|
|
Quilting for Beginners |
$ |
|
Level V Dolphins(formerly
Adv Beginner) |
| boys & girls, 6-15 |
|
$50 for six week session |
|
Front/back with turn |
| Basketball |
|
|
|
Spring Break Soccer |
$ |
|
Variety of stroke work |
| boys & girls, 8-14 |
|
$45 per person |
|
Stroke turns Survival Float |
| Soccer
Clinic |
|
|
Sidestroke - 2
widths Treading water |
| boys & girls, 6-14 |
|
Diving board diving |
| Volleyball
Clinic |
|
|
Level VI Sharks(formerly
Intermediate) |
| boys & girls, 8-15 |
|
Stroke perfection(racing
strokes) |
| Arts
& Crafts |
|
|
Endurance swim Turn perfection |
| boys & girls, 4-13 |
|
Racing
starts |
| Racquetball
Clinic |
|
|
Beginner lifesaving
skills |
| boys & girls, 7-12 |
|
Session Dates Session Times |
| Sports Enhancement |
|
|
1. June 12-23 10:05-10:30 |
| boys & girls, 7-12 |
|
2. June 26-July
7
10:35-11:00 |
| Intro
Skate park Skating |
|
|
3. July 17-28 11:05-11:30 |
| boys & girls, all ages |
|
4. July 31-Aug 11 11:35-12:00 |
|
Evening 7:10-7:40 |
|
Evening 7:45-8:15 |
|
LEVEL SESSION TIME |
|
SESSION # |
| TOTAL $ |
|
TOTAL $ |
|
TOTAL $ |
| ($15.00
registration fee $20.00 if not in |
|
($25.00 per session) |
| Prosser
School District) |
|
|
| ($10.00 late fee after
deadlines |
|
|
| baseball/softball
May 12 all other May 19) |
|
|
| I am fully aware of the special dangers
and risks inherent in the activity, including physical injury, death or other
consequences that may arise or result directly or indirectly from the
activity. Being fully informed as to
these risks and in consideration of the privilege of participating in the
described activity, I hereby assume all risk of injury or liability and waive
any right of recovery from or to bring suit against the City of Prosser for
any personal injury, death or other consequences arising out of participation
in the activity, except for the sole negligence of the City of Prosser. |
|
| In the event the participant is injured, or
becomes seriously ill, and I cannot be reached, I authorize the program
director or any program personnel, to seek and authorize any and all
hospitalization, medical, dental, and/or surgical treatment, deemed advisable
by the circumstances. I understand
that I have read and do fully understand all of the above. |
|
| I certify that I am the participant or
legal guardian/parent of the participant named above; that I have read and
fully understand the foregoing release; and that I join in the release
without reservation, granting full consent and authorization for the above
named person to participate in the activity. |
|
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| Signature
of Parent/Legal Guardian |
|
Date |
|
| Office use only: Do not write in this box |
| AMT
PD___________CHECK____________CASH___________REC#______________DATE__________ |
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