First Name
Middle Name
Last Name
Date of Birth
Age
Gender
Home Address
City/Suburb
State/Province
Postal/Zip Code
Phone Number
Email Address
First Name
Last Name
Relation to Student
Phone Number
Email Address
First Name
Last Name
Relation to Student
Phone Number
Alternate Phone Number
Has the student taken swimming lessons before?
If yes, please describe the student's swimming experience and level.
Does the student have any fears or concerns about the water?
If yes, please explain.
Does the student have any medical conditions or allergies that we should be aware of?
If yes, please specify.
Does the student require any special accommodations?
If yes, please explain.
Please select the desired class level.
Parent & Tot (6 months - 3 years)
Preschool (3-5 years)
Learn-to-Swim Level 1: Introduction to Water Skills
Learn-to-Swim Level 2: Fundamental Aquatic Skills
Learn-to-Swim Level 3: Stroke Development
Learn-to-Swim Level 4: Stroke Improvement
Learn-to-Swim Level 5: Stroke Refinement
Learn-to-Swim Level 6: Swimming and Skill Proficiency
Adult Swim Lessons
Private Swim Lessons
Preferred Class Day(s).
Preferred Class Time(s).
How did you hear about our swimming classes?
Notes/Comments.
Registration Fee
Payment Method
Online
Cash
Check
Card
I, the undersigned parent or legal guardian of the above-named student, hereby give permission for my child to participate in the swimming classes offered by (Company Name). I understand that there are inherent risks involved in any aquatic activity, and I voluntarily assume those risks on behalf of my child. I hereby release, waive, discharge, and hold harmless (Company Name), its owners, employees, and agents from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury, including death, that my child or I may sustain while participating in the swimming classes.
Parent/Guardian Signature
To configure an element, select it on the form.