SWIM AND SCUBA

CLASS REGISTRATION FORM

1) Complete all the fields below 

2) Use the TAB key to move from field to field        

3) Click on the SUBMIT button at the end

4) Please submit one form per student.

5) We will contact you by phone and/or e-mail to confirm your registration.  

Thank you.

If you or one of your children has swam with us before, click here    

If you've never been with us before, how did you hear about us?

Student name:  First    Last

Please tell us about any health issues of which we should be aware? (asthma, back trouble, etc.)    

Student birthdate (mm/dd/yy):

Contact parent's name      

Phone #s (w/area code)  Home  Work/cell

Second parent's name   

Second parent's work phone or cell phone #  

E-mail address   

US mail address:    Street   

City     State          Zip Code   

Member status   

In which class are you interested:

Private      Semi-Private      Trio      IPAP (mommy/daddy &me)  

Eclectic Aquatics     Swim Team Prep (Tues 7pm)   Swim Team Prep (Thurs 7:00pm)  

Adult Swim      Aerobics     Arthritis Aquatics Program   

If you checked Aerobics, please number the classes in the order in which you'd prefer. If you wish to attend two classes, please let us know in the space provided at the bottom of this form.  Leave a box blank if you can not attend at that time:

Sun 9:00am    Mon 7:00pm    Tue 9:30am       Fri 9:30am    

If you checked IPAP, please number the following classes in the order in which you'd prefer to attend.  Leave a box blank if you can not attend at that time:

 Wed 9:30am     Wed 7:00pm    Sat 9:00am   Sat 9:30am

If you checked Private, Semi-private, or Trio, please tell us what times you could come on each of the following days:

Monday     

Tuesday     

Wednesday

Thursday    

Friday         

Saturday     

If there is a particular instructor you'd like to have, please let us know here.  Thank you.

If you checked Private, Semi-private, or Trio, please tell us what water skills your child currently possesses.  This will allow us to determine what level he or she is in.  If your child swam with us before, please tell us what level your child was in.

Please use the space below to give us any additional information you feel is pertinent (i.e. if you are flexible on the type of class: private, semi, or trio).  Thank you.

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