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Swim Lesson Evaluation Registration

  1. 1 = Uncomfortable in the water 

    5 = Can swim laps 

  2. The assessment is required to be completed before the student can be registered for swim lessons. The assessment and registration should no exceed 30 minutes. All assessments will take place at the Manchester Recreation Complex. Our aquatics team will reach out to you after we have received your assessment form. You can also complete this form on our website. Ages 4 – 17 are able to participate. Ages six months – three years may participate in our Parent and Child session. The parent or guardian will be in the water with the child. This is an instructor led class.
  3. The undersigned agrees that each person using the Manchester Parks and Recreation facilities pursuant to this application will do so at this or her own risk. The undersigned affirm that he or she know of no reason which should cause any of such persons to limit their physical exercise in any of the activities at the Manchester Recreation Complex. The undersigned releases and agrees to identify and hold harmless the City of Manchester, its elected officials, volunteers, employees, and instructors, from any claim or liability for death, injury, or other loss arising from the negligence or gross negligence from the City. The city of Manchester does not provide additional personal injury insurance. There is a $20 fee for all returned checks. Customer will be responsible for costs of collection including 33 1/3 collection costs, court costs, and attorney fees.
  4. Photographic Release: I do herby consent and authorize the City of Manchester Parks and Recreation Department to reproduce photographs and/or videos taken of myself or my child for advertising and publicity purposes
  5. If you do not consent to the photographic release, enter "NA". 

  6. Leave This Blank:

  7. This field is not part of the form submission.