Program Registration
( Lakeside programs are for CLUB MEMBERS ONLY)

 

Please print and complete this form.  Once completed, please mail to the address below.

 

Program Title:                                                                                                         
Session Date:                                                                           
Level:                                                                           
Time:                                                                           
Participants Name:                                                                                                         
Age:                         
Birthdate:                                                
Address:                                                                                                         
City/State:                                                                                                         
Home Phone:                                                
Parent's Name:                                                                                                         
Work Phone:                                                
Email:                                                                                                         
Special Considerations:                                                                                                                                                      
                                                                                                                                                                                              

 

Mail To:

Lakeside Swim Club Program Office

2010 Trevilian Way

Louisville, KY 40205

 

Office Use Only:
Payment: Cash:                              Check:                             
Registrar:                                                                                 
Date