Summer 2012 - Mt. Hood Community College

MAIL TO:Registration for both children’s activities and adult programs will be held at the same time.Online Registration opens Wednesday, May 23, at 8 a.m. Please go to mhcc.edu/aquatics to register. You must have a credit card to process the transaction and there will bean additional 6 percent fee for processing.Telephone Registration opens Thursday, May 24, from 8 a.m.-noon. Call 503-491-6065during this four-hour registration period. Call 503-491-7243 after this time. Please haveyour credit card number ready and your first three choices of classes. Swim lesson leveladvice will not be available during this time. Please call the Aquatic Center before this datefor proper placement. Receipts will be mailed to you.Walk-in Registration and Mail-in Registration open immediately after telephoneregistration ends at noon on May 24. For mail-in registration, forms are available in thisbrochure and online. Please enclose a check or money order along with your first threechoices of classes. Receipts will be mailed.MHCCAttn: Aquatic Center Registration26000 S.E. Stark StreetGresham, OR 97030After May 24 all four options for registrationwill be continuously available throughout thesummer. Please note online registration is notavailable on Sundays.Mail-in registration .accepted after May 24, 2012.Mt. Hood Community College Aquatic CenterSummer 2012 RegistrationMail-in registration accepted beginning May 24Please note sessions with fewer than 10 classes per session will be discounted. Call ahead for pricesbefore enclosing payment. All over-payments will be credited to your registration account.Adult RegistrationAdult Registering for ChildPayment: Check/VISA/MasterCardAmount Enclosed: $_______Last NameParent’s Last NameName on credit cardSignatureFirst Name, Middle InitialParent’s First NameMICard NumberExpiration DateChecks payable to: MHCCPlease return with paymentenclosed to:.Aquatic Center Registration26000 S.E. Stark St.Gresham, OR 97030Child’s Last NameChild’s First Name MIChild’s Birth Date (MM/DD/YY)Street AddressCity State ZipHome Phone Work Phone Email Address1st Choice2nd Choice3rd ChoiceSession Class Day(s) TimeETHNIC DATAAM - American Indian/Native AmericanAS - Asian, Pacific IslanderBL - Black, Non-HispanicHI - HispanicUN - UnknownWH - White, Non-HispanicHIGH SCHOOL COMPLETIOND - Adult high school diplomaG - GEDH - High school graduateN - Did not completeS - Still in high schoolU - UnknownHIGHEST DEGREE LEVEL0 - None1 - Other (short term training)2 - One-year College Certificate3 - Two-year College Certificate4 - Bachelor’s degree5 - Master’s degree6 - Ph.D. or professional degreeMt. Hood Community College does not provide accident insurance for participants inswimming lessons. It is the responsibility of the parent to provide for this need. The parent/guardian, by signing this form, confirms this statement has been read and understood.Signature __________________________________Mt. Hood Community College 15