Registration
IF YOU ARE A CURRENT CUSTOMER NO NEED TO FILL THIS FORM OUT. SIMPLY REACH OUT TO US AND WE CAN RUN IT DIRECTLY THROUGH YOUR SWIM ACCOUNT. New Customers - Purchase a Gift Certificate for your favorite lil' swimmer in any amount using this form! Once you submit your order, we will process it and send you a confirmation email and receipt. Gift Certificates are mailed within 3 days and expire December 2024. (Please ignore the request for an Emergency Contact by entering 'N/A' in the box.)
Event:
Start Date/Time: End Date/Time:
Fee per Family: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info (Not Contact #1 or #2)*
 
 
 
Questions/Options:
What amount would you like to purchase?*
Who is the Gift Certificate for?*
Who is the Gift Certificate from? (Include a short, personal message here if you'd like.)*
Are we mailing the Gift Certificate to the recipient?*
Mailing Name & Address*
 
Additional Information:
 
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*