Registration Form for the Harrisville Swim Lessons – 2018

Forms may be mailed to: Kyle Anderson,   Jaquith Road Harrisville, NH 03450 or scanned and emailed to

*  Note:  Please fill out one form per swimmer.

Name:________________________________ D.O.B.__________


Phone Number(s):______________________________________


(used often – for important information like cancellations due to weather)

Please check the swim time that you plan to attend during the summer session.  Refer to the level requirements. The parent or guardian must watch their child while the child is participating in  the lesson(s).

_______9:00 am – 9:30 am – Teen and Adult Swim Tips

_______9:30 am – 10:00 am –Pre-Level One

(parents  must go in the water with their children)

_______11:00 am – 11:30 am  – Level One

_______11:30 am – 12:00 pm – Level Two

_______12:00 pm – 12:30 pm – Level Three

_______12:30 pm – 1:00 pm – Level Four, Five, and Six

Information that you feel will be helpful and important for the instructor to know about your child while they are taking swimming lessons. Any medical needs, special services need, etc. please contact the instructor prior to lessons.


This is not a school sponsored event.