Open Water Adventures Online Registration

Registration

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Hey New Friend! You've found the right place - the hidden gem for quiet small group swim lessons in the Charlotte area. Once you've completed the form below you'll be redirected to our Parent Portal where you can choose a timeslot to get started right away. Some options may be available for waitlisting only. Alternatively - give us a call or text (980-272-7946) and let our schedule tetris expert find options that will work for your whole family.

* denotes required fields

Family Information

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Preferred Day of the Week?*

Available 9am-1pm Weekdays?*

Available 4pm-5pm Weekdays?*

Available 5pm-8pm Weekdays?*

Available 9:30-1pm Saturdays?*

Contact #1

Primary Contact First Name*

Last Name *

Relationship to Student*

How Can We Contact You?

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Secondary Contact First Name

Last Name

Relationship to Student

How can we contact you?

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

Student requires special accommodations for physical or mental disability? If Yes please explain:

Any history of Anxiety, extreme fear, trauma, or PTSD related to water/swimming, noise or crowds?

Allergies to Food, Medication, Insect stings, environmental, seasonal? If yes, please explain:

Medications Used Daily - This information will only be used in the event of a medical emergency.

Any history of Asthma, wheezing, inhaler use? If yes, please explain:

Taken Swim Lessons Before?*

Where? (Name of facility)

Can they swim without a float?

Floats on back independently?

Comfortable in 6' deep water?

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

Student requires special accommodations for physical or mental disability? If Yes please explain:

Any history of Anxiety, extreme fear, trauma, or PTSD related to water/swimming, noise or crowds?

Allergies to Food, Medication, Insect stings, environmental, seasonal? If yes, please explain:

Medications Used Daily - This information will only be used in the event of a medical emergency.

Any history of Asthma, wheezing, inhaler use? If yes, please explain:

Taken Swim Lessons Before?*

Where? (Name of facility)

Can they swim without a float?

Floats on back independently?

Comfortable in 6' deep water?

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

Student requires special accommodations for physical or mental disability? If Yes please explain:

Any history of Anxiety, extreme fear, trauma, or PTSD related to water/swimming, noise or crowds?

Allergies to Food, Medication, Insect stings, environmental, seasonal? If yes, please explain:

Medications Used Daily - This information will only be used in the event of a medical emergency.

Any history of Asthma, wheezing, inhaler use? If yes, please explain:

Taken Swim Lessons Before?*

Where? (Name of facility)

Can they swim without a float?

Floats on back independently?

Comfortable in 6' deep water?

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

Student requires special accommodations for physical or mental disability? If Yes please explain:

Any history of Anxiety, extreme fear, trauma, or PTSD related to water/swimming, noise or crowds?

Allergies to Food, Medication, Insect stings, environmental, seasonal? If yes, please explain:

Medications Used Daily - This information will only be used in the event of a medical emergency.

Any history of Asthma, wheezing, inhaler use? If yes, please explain:

Taken Swim Lessons Before?*

Where? (Name of facility)

Can they swim without a float?

Floats on back independently?

Comfortable in 6' deep water?

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

Student requires special accommodations for physical or mental disability? If Yes please explain:

Any history of Anxiety, extreme fear, trauma, or PTSD related to water/swimming, noise or crowds?

Allergies to Food, Medication, Insect stings, environmental, seasonal? If yes, please explain:

Medications Used Daily - This information will only be used in the event of a medical emergency.

Any history of Asthma, wheezing, inhaler use? If yes, please explain:

Taken Swim Lessons Before?*

Where? (Name of facility)

Can they swim without a float?

Floats on back independently?

Comfortable in 6' deep water?

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)