MCPARC Swim Lesson Registration 2024
All fields must be completed.  Registration and payment for Session I due by June 19th and for Session II by July 3rd.  Participant fee $40 + $2 processing fee per session.  Participants may sign up for any session they prefer, but may only sign up for 1 session.   
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MCPARC will be offering two sessions of swim lessons.  Class will be held Monday through Friday , 9:30am - 10:30am at 12th Street Pool.

Please complete this on-line form and either click the link at the end to make payment or mail in payment to validate your registration.  Checks can be mailed to MCPARC PO Box 1258 Fairmont, WV  26555 or you can stop by the office to pay.  (1000 Cole Street, Suite B  Pleasant Valley, WV  26554)   info@mcparc.com           304-363-7037

All registered participants will receive an email notification on June 21st for Session I or July 5th for Session II.

Childs First Name *
Childs Last Name *
Childs Age *
I am registering for the following session:
Childs Skill Level *
Parent/Guardian Name (first and last) *
Parent/Guardian Mailing Address (street, city, zip code)
 *
Parent/Guardian Phone #
 *
Parent/Guardian Email Address
 *
Additional Parent/Guardian Name (first and last) *
Additional Parent/Guardian Phone #
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I hereby give my permission for my child to participate in the Marion County Parks & Recreation Swim Lesson Program. Participation in any program which involves physical activity exposes the participant to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the participant from all conceivable dangers. I hereby affirm that my child has no conditions that would make it unsafe for him/her to participate in the Swim Lesson Program.
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Required
Medical Consent: I understand that MCPARC will make every effort to contact me in the case of an emergency. I give my permission for MCPARC to administer any medications needed and to provide and arrange for and consent to any necessary medical treatment for my child while participating in the Swim Lesson Program including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.   
 *
Required
Photography Release
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By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my child, I hereby voluntarily release and forever discharge Marion County Parks & Recreation Commission, its trustees, officers, employees, agents, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my child's participation in the Swim Lesson Program. I agree, for myself and my child, not to make any type of legal or equitable claim on MCPARC, or any of its trustees, officers, employees, agents, insurers or contractors with respect to any injury I or my child may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with the Swim Lesson Program, including other participants. I further agree that if any such claim is made, I will indemnify and defend MCPARC with respect to any such claim, injury or damage.
Please fill in parent/guardian's full name as an indication of your signature. *
A copy of your responses will be emailed to the address you provided.
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