Register for Swim Lessons 2025 - Water Safety Patrol

"*" indicates required fields

Parent’s Name*

First Last

(if participant is under 18 years old)

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Number of Participants you are registering for today:

Participant 1

Participant’s Name*

Age*

Program Desired*

Level of Lesson Desired*

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Twice Per Week Options ($45)*

Once Per Week Options ($35)*

Please list any medical conditions or concerns

Participant 2

Participant 2 Name*

Participant 2 Age*

Participant 2 Program Desired*

Participant 2 Level of Lesson Desired*

Twice Per Week Options ($45)*

Once Per Week Options ($35)*

Please list any medical conditions or concerns

Participant 3

Participant 3 Name*

Participant 3 Age*

Participant 3 Program Desired*

Participant 3 Level of Lesson Desired*

Twice Per Week Options ($45)*

Once Per Week Options ($35)*

Please list any medical conditions or concerns

Participant 4

Participant 4 Name*

Participant 4 Age*

Participant 4 Program Desired*

Participant 4 Level of Lesson Desired*

Twice Per Week Options ($45)*

Once Per Week Options ($35)*

Please list any medical conditions or concerns

Participant 5

Participant 5 Name*

Participant 5 Age*

Participant 5 Program Desired*

Participant 5 Level of Lesson Desired*

Twice Per Week Options ($45)*

Once Per Week Options ($35)*

Please list any medical conditions or concerns

Participant 6

Participant 6 Name*

Participant 6 Age*

Participant 6 Program Desired*

Participant 6 Level of Lesson Desired*

Twice Per Week Options ($45)*

Once Per Week Options ($35)*

Please list any medical conditions or concerns

Electronic Signature of parent or authorized adult*

Total

Credit Card*

Cardholder Name

Card Details