Class Registration Form

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Fill Out the Registration form below

Please fill out form completely (indicate no or none if applicable)

How did you hear about us?

Member Status

Last Name

First Name

Your Email

Street Address

City

State

Zipcode

Please tell us of any health issues

Date of Birth

Parent's Name

Parent's Home Phone

Parent's Cell

Second Parent's Name

Second Parent's Cell

In which classes are you interested?
PrivateSemi-PrivateTrio

IPAP (Mommy/Daddy & Me)Adult SwimAerobicsEclectic AquaticsArthritis Foundation Aquatics

Swim Team PrepLifeguardingSwim Instructor TrainingScuba Training

If you checked Aerobics, please indicate which classes you are available to attend. 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:

Sunday 9:00 AMMonday 7:00 PMTuesday 9:30 AMThursday 9:30 AMFriday 9:30 AM

If you checked IPAP, please check the classes which you can attend. Leave a box blank if you can not attend at that time:

Wednesday 9:30 AMWednesday 7:00 PMSaturday 9:00 AMSaturday 9:30 AM

If you checked Private, Semi-private, or Trio, please tell us what times you could come on each of the following days- if you are not available that day- write in no/none (do not leave a box blank):

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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):

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