Take The Plunge - Information Signup

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Thank you for your interest in Take The Plunge, a children's lap swim program offered by Richmond Swims. Although we don't have any sessions currently available, if you sign up here, we will notify you the next time we run this program.
Additionally, having a list of interested people helps us to raise funds and schedule new sessions.

Thank you for completing this form!

Parent's First Name *

Parent's Last Name *

Email address *

Home Street Address *

City *

Zipcode

Phone Number (w/area code) *

Child's First Name *

Child's Last Name *

Child's Age *

Child's Race *

African American

Asian/Pacific Islander

Caucasian

Hispanic

Latino

Mixed Race

Other

Required

School *

Chavez

Coronado

Ford

Lincoln

Nystrom

Peres

Washington

Other:

Does your child qualify for free or reduced lunch at school? *

Yes

Do any of these apply to the child's family?

Calworks

Section 8 Housing

Covered California/Medi-Cal

SNAP

Homeless Coalition

Family income at or below state poverty level

How did you find out about Take the Plunge? *

School

Friend

Nextdoor

Other:

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