Swimming Lessons Registration

Please submit one form per child enrolled.

Participant Information
Swimmer's Name
First Last
Swimmer's Date of Birth*
Date Format: MM slash DD slash YYYY
Swimmer's Gender*
Parent or Guardian Information
Last Name*
Father
Mother
Home Address*
Street Address Address Line 2 City State ZIP Code
Home Email Address*
Mother's Home Phone
Mother's Work Phone
Mother's Cell Phone
Father's Home Phone
Father's Work Phone
Father's Cell Phone
Emergency Contact*
First Last
Emergency Home Phone*
Emergency Cell Phone*
Swimming Lesson Selection
Please select the type of lesson and quantity you would like to register for and we'll be in touch to schedule the times.
Monthly Group Lessons
Price: $65.00 Quantity:
Fast Track (Two week Monday - Thursday)
Price: $120.00 Quantity:
Private Lesson 4-Pack
Price: $200.00 Quantity:
Total
$0.00

Participant Information