Speer Swim School, LLC Online Registration

Registration

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IF YOU ARE ALREADY A CUSTOMER CLICK THE LINK ABOVE. All SPLASH, VILLA and MNHS registrations will be charged IN FULL within 48 hours of registration. All MOBILE REGISTRATIONS will be charged an annual registration fee of $30 PER STUDENT or $100 PER FAMILY upon booking. Your tuition will be charged after an exact time and class type has been confirmed with you. All Splash Club clients who are not members will need to pay their $50 non-member fee through Splash Club's website

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Splash , MNHS, or Mobile *

Pool sharing/lesson with who?

If mobile lesson: POOL Address

Is pool address same as home?

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Prior swim lessons? Where?*

Current level*

PROMO CODE if applicable

By registering, you are holding space in a specific class, so we are unable to offer refunds, credits or makeup lessons if you miss. The tuition will be charged in full within 48 hours of registration.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Prior swim lessons? Where?*

Current level*

PROMO CODE if applicable

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Prior swim lessons? Where?*

Current level*

PROMO CODE if applicable

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Prior swim lessons? Where?*

Current level*

PROMO CODE if applicable

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Prior swim lessons? Where?*

Current level*

PROMO CODE if applicable

Enroll in Classes

Select Class

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

Referral Information

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

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

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