“Splish Splash”

2024 “Splish Splash” Water Safety Swim Program

Application

Vivian Stancil Olympian Foundation, Inc
P. O. Box 5536
Riverside, CA 92517
(951) 462-1165

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Date *

Name *

First

Last

Address

City , State, Zip Code

Phone Number *

Email *

Events/Activities (fee taken at the gate) *

• Safety Swim Lessons – $ 0.00
• Water Aerobics – $ 5.00

Approval of photgraphic images be used on website or literature: (circle one) *

• YES
• NO

Comment or Message

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