Registration
Autism Family Open Swim 5:00-7:00 pm - For families with children with Autism - $5.00 per family to be paid the night of open swim. The whole family is welcome to attend and swim. Parents should bring suits to be in the water with their children. We have staff supervising, but parents are responsible for their children.
Event:
Start Date/Time: End Date/Time:
Room:
* - denotes required fields
Contact Information:
First Name:* Last Name: *
Type:
Home Phone: * Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact
Information:
 
 
 
Questions/Options:
Please list the names of the children and their age attending from your family.
Please list the names of the adults attending from your family.
We will be serving cheese pizza. Please indicate how many people will be eating pizza so we can plan accordingly.
 
Additional Information:
 
 
Other Questions/Comments: