FY26 Group Swim Participation Form – Swim Safe Massachusetts

Please read through this document carefully before reaching out with any questions or completing/submitting a bid response

ATTACHMENT 1 – SWIM SAFE MASSACHUSETTS 2026 SWIM LESSON PARTICIPATION FORM

FY26 Participation Form

(One form per Family)

FREE GROUP SWIMMING LESSONS

In an effort to expand access to swimming lessons across the Commonwealth, particularly in environmental justice communities, and in order to help DCR lifeguard candidates develop the swimming proficiency needed to complete a lifeguarding certification course, the Massachusetts Department of Conservation and Recreation is working with organizations to help provide free group swim lessons. Funding will be available to cover the costs of both youth and adult group swim lessons occurring through June 30, 2026.

INSTRUCTIONS: Please complete this form for all persons within your immediate family that will be participating in DCR-sponsored swim lessons. Required fields (*) must be completed in order for DCR to fund the swim lesson. Required data is used solely to substantiate billing from the swim lesson provider. Demographic data is requested to help us better assess whether, in aggregate, this funding is reaching intended recipients. We thank you for volunteering this information.

	Age* (years)	First Name*	Last Name*	Gender* M/F/NB	Race* W/B/H/A/NA	Prior SWIM Participation* Yes / No
Participant 1:*
Participant 2:
Participant 3:
Participant 4:

Parent/Guardian Name:* (Required for participants under 18 years of age)

Participant or Parent/Guardian Email:*

City/Town of Residence:*

What is your annual household income:*

Less than $30,000 $75,001 – $100,000 $30,001 – $50,000 $100,001 – $125,000 $50,001 – $75,000 Greater than $125,000

Participant Signature:*

(For participants 18 years of age or older)

Parent/Guardian Signature:*

(For participants under 18 years of age)

Date:*