SWIM REGISTRATION
 


You can list multiple programs for each child. All information is confidential. Any email correspondence will be sent as a blind copy for your privacy. You will also be asked to sign a liability waiver upon the start of the program.

*=Required
Parents/Guardian
Mother Name*:
Cell Phone:
Father Name*:
Cell Phone:
Home Phone*:
Email*:
Membership #
Children
Child 1      
Name Age DOB Allergies or Medical Conditions?
Session: Possible Group:
     
Child 2      
Name Age DOB Allergies or Medical Conditions?
Program: Session: Possible Group:
     
Child 3      
Name Age DOB Allergies or Medical Conditions?
Program: Session: Possible Group:
     
   
For Additional Children or Programs, please submit this form and contact Tim to complete registration.




 




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