Champlain, NY · Clinton County
Summer Swim Program Registration Form
Parents or guardians use this form to register children for the Town of Champlain’s 2025 summer swim program and provide swimming levels and emergency consent.
What this form is
This registration form is for families seeking a place in the Town of Champlain’s 2025 instructional swim program at the NCCS Pool. It asks for each child’s name, age, date of birth, sex, and swimming level, along with parent or guardian contact information and a signed liability waiver. Residents within the listed tax boundaries attend free; eligible children outside them may participate for $40 per child if space is available.
Who needs it
A parent or guardian registering one or more children age five or older for the 2025 swim program should complete and sign this form.
How to submit it
Email the completed, signed form to Charlene Sample at [email protected]. The form states that registration was due by June 13, 2025; families outside the listed tax boundaries must include full payment of $40 per child.
About notarization
This document is signed without a notary; the parent or guardian signs and dates the form and no notarized attachment or sworn step is listed.
How to submit this form
- 1
Download The Form
Download the Summer Swim Program Registration Form.
- 2
Complete Child And Guardian Details
Enter each child’s information and swimming level, plus the parent or guardian’s contact details.
- 3
Review And Sign
Read the waiver and release, then have the parent or guardian sign and date the form.
- 4
Submit The Registration
Email the completed form to [email protected]; include full payment if the child is outside the listed tax boundaries.
Frequently asked questions
- Who can register a child for the swim program?
- A parent or guardian can register a child age five or older. The program is free for the listed local tax boundaries; children outside them may attend for $40 if space is available.
- Do I need a notary for the Swim Program Registration Form?
- No. The parent or guardian signs and dates the form; it lists no notarized attachment or sworn step.
- How do I submit the Swim Program Registration Form?
- Email the completed, signed form to Charlene Sample at [email protected]. The document gives a June 13, 2025 registration deadline.