National Sports Center for the Disabled - outdoor recreation opportunities for individuals with disabilities

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     • Golf
     • Cycling Classes
     • Cycling Rides
     • Canoeing
     • Swim Lessons
     • Family Fun
• KC Winter Programs
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Advisory Board
• NSCD-KC
Membership
• Internships

Date:
Session 1 - June 16-25, Tues & Thur, 6 - 6:45 Youth Beginners
Session 2 - June 16-25, Tues & Thur, 7-7:45 Youth Intermediate
Session 3 - July 9-18, Tues & Thurs, 6-6:45, Youth Beginners
Session 4 - July 9-18, Tues & Thurs, 7- 7:45 Youth Intermediate
Session 5 - July 21-30, Tues & Thurs, 6:6:45, Youth Beginners
Session 6 - July 21-30, Tues & Thurs, 7-7:45 Youth Intermediate

Location: Tony Aguirre Community Center
2050 West Pennway Terrace, KC, MO 64108

Swim Lesson Registration Form
Session:	* required
Participant First Name:	*
Participant Last Name:	*
Parent/Guardian Name:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
Email Address:	*
Age:	*
Date of Birth:	*
Sex:	Male Female *
Payment by credit card or check made out to NSCD.
*Please charge my Credit Card:
*Card #
*Expiration Date:	Month: Year:
*Name as it appears on card:
Emergency Contact:	*
Emergency Contact Phone:	*

If paying by check, please make check payable to NSCD and mail to:Please mail registration to: NSCD-KC 1801 Bryant St., #1500 Denver, CO 80204
Photo Release

I grant permission for Participant's picture to be used in publicity or brochures related to this event.
Agree:	Yes No *
Participant Name:	*
Parent/Guardian Signature:	*
Date:	*
By checking this box, this will act as your digital signature.	I agree
Please print this page out and bring it to the lesson with you.

P.O. Box 1290, Winter Park, Colorado 80482 USA ph: 970.726.1540 or 303.316.1540 fx: 970.726.4112
Denver Office: 1801 Bryant St, Ste 1500, Denver, CO 80204 ph: 303.293.5711 fx: 303.293.5448 Email: info@nscd.org
KC Office: 4600 E. 63rd St, Kansas City, MO 64130 ph: 816.513.7571 Email: infokc@nscd.org

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