4 openings left in this event!
Please fill out the full registration form below to register for your free swim lessons! Upon completion, you will receive a phone call from a Njswim team member to schedule your lessons. Your swimmers class will meet once a week for 30 minutes. Once your swimmer is enrolled, you will receive a confirmation email with enrollment details. Njswim looks forward to meeting you!
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info
Students entered below will be added to your family's account
your child can swim independently at least 20 meters without a flotation device?*
Additional Information:
Medical Emergency
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Signature text/ Release of Liability
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Enter your Full Name: *   
Other Questions/Comments: