Elmhurst Public Schools

Community Unit District 205

Elmhurst, Illinois

District 205 Aquatic Center Registration

I wish to register for the following District 205 Aquatic Center Activity

Morning Adult Lap Swim

Winter/Spring  2006 -  6-7am

Dates: 01/3,4,5,10,11,12,13,17,18,19,20,23,24,25,26,30,31

02/1,2,6,7,8,9,13,14,15,16,17,21,22,23,24,27,28

03/1,2,6,7,8,9,13,14,15,16,20,21,22,24,--- Spring Break

04/3,4,5,7,10,11,12,13,17,18,19,20,25,26,27,28

05/1,2,3,4,5,8,9,10,11,15,16,17,18,23,24,25,26

I understand and agree that this activity is voluntary.  I understand that the program may involve certain health risks and I assume all responsibility for those risks and agree not to make any claim against School District 205, the Board of Education and its members, Officers, and employees for any injury or illness suffered as a result of my participation in the activity.

I hereby declare myself to be physically sound, having medical approval to participate in this activity.

______________________________                        ______________________________

Participant’s Name (please Print)                                  Participant’s Signature

______________________________                        Make checks payable to:

Date                                                                                         York High School

                                                                                    Mail to:

______________________________                                    Dave Davis

Address                                                                                   Aquatic Director

York High School

______________________________                                    Elmhurst, IL 60126

Phone Number

______________________________

email for confirmation

Punch Cards can be picked up after 01/03/06 from 6-7am in the Aquatic Center