Swim Empowerment Funding Registration 2025

Swim Empowerment Funding Registration Form
Completing the following form is required to confirm funding for your child's swimming lessons and registration at your local YMCA. Please use a separate form for each additional child. Registrations are filled in order of receipt and according to availability at each YMCA.
Name of Parent/Guardian*

First NameLast Name
Name of Child*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
PLEASE ENTER A VALID EMAIL! WE WILL USE THIS TO CONTACT YOU.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YMCA Branch lessons will be taken at*

Cranston YMCAEast Side/Mt. Hope YMCAKent County YMCA (Warwick)Newman YMCA (Seekonk, MA)South County YMCA (Peace Dale)West Bay Family YMCA (North Kingstown)YMCA Camp Fuller (Wakefield)Newport County YMCA (Middletown)Pawtucket Family Branch YMCAOrca Aquatics
Swim Lesson start date*

MonthDayYear
Is the child a member of the YMCA?*

Yes, child is a memberNo, child is not a member
Age of Child (Must be 5-19 years old)*
Ethnicity of Child*
How did you hear about Swim Empowerment?*
Let us know how you heard about our swim program. (Be specific!)
Enter the message as it's shown*
Should be Empty:

Swim Empowerment Funding Registration Form