Registration

Please fill out a registration form below after reviewing the policy page.

Your Name

First Name

Last Name

Name of your child (if applicable)

First Name

Last Name

Date of Birth (of the participant)

MM

DD

YYYY

Phone

(###)

###

####

Email

If looking for lessons at your house, Please provide address of location

Please state which class you are looking for

example: Preschool 1, CPR-C, etc.

Preferred days and times

Can be weekly, daily or dates at random.

Please state any medical concerns that we may need to be aware of

Number of Lessons

8, 10, or 12 (Additional lessons can be added)

Samantha’s Swim School