City of Memphis s2

City of Memphis Division of Park Services, Aquatics & Make a Splash Mid-South Pilot Swim Lesson Program

Free Swim Lesson Verification Form

Name of Swimmer:______

Name of Parent/Guardian Registering Child:______(Parent or Guardian only must register child)

Date: ______

Document verification: Please place a check next to the documents received and verified, as well as answer the following questions:

______Birth Certificate for the child

______Driver’s License or Photo ID for the Parent or Legal Guardian

Yes or No Does the Parent’s name on the birth certificate or Legal Guardian documentation match the photo ID (please circle)

Free Swim Lesson Verification (Please check the type of document that was presented and attach to the application)

______AFDC Award Letter

______Food Stamp Award Letter (child’s name must be listed)

______Social Security for the Child (child’s name must be listed)

______Disability for the child (child’s name must be listed)