BTSC Lesson Registration Form 2010-11

To register fill out form then save and email to coachdale_1@msn.com, or print and  fax to 240-221-3109 or mail to BTSC, 2604 Baywood Court,  Silver Spring, MD  20906.  Payment must accompany registration.  Payments will not be processed until after the first lesson to assure that you are satisfied.  No refunds will be given.

Swimmer Information:

Name      Age:          Birthdate:  

Street Address      City   Zip

Home Phone 

Parent/Guardian  Information

Name

Best Contact Phone Number                   Email 

Please fill out the scheduling and group information below. 

Please select Session/s :  Please select Level and Day you wish to attend. 

Session    

         Session I: 9/13-10/8        Session II: 10/11-11/5       Session III:  11/8-12/10     Session IV: 1/3-1/28     

  Level

       Level 1 (5:30-6:00)                                   Level 2 (5:00-5:30)                      Level 3 (4:30-5:00)

 Schedule

   Monday         Tuesday           Wednesday                  Thursday            Friday

                Payment Method  (Payment is due upon Registration)   Make Checks payable to BTSC, and mail to BTSC, 2604 Baywood Ct., Silver Spring, MD 20906.   You may fax registration to 240-221-3109 or email to coachdale_1@msn.com

  Check       Credit Card       Card Type      Name on Card:        Card #  

                                                                 Exp Date       Code