Charlotte Aquatics Online Registration

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Charlotte Aquatics..... Swim Like A Fish!

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Referral Information

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Family Information

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Home Address*

City*

State*

Zip*

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Additional Info

Emergency Contact Info

Contact #1

Contact #1 First Name*

Last Name *

Type*

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Work #

Cell #

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Contact #2

Contact #2 First Name

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Type

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Work #

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Student #1

Student's First Name*

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Student Gender*

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Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Classes meet once per week for 30 minutes. Please choose a time that works the best for you since make-up classes are limited

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Classes meet once per week for 30 minutes. Please choose a time that works the best for you since make-up classes are limited

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

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Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Classes meet once per week for 30 minutes. Please choose a time that works the best for you since make-up classes are limited

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Classes meet once per week for 30 minutes. Please choose a time that works the best for you since make-up classes are limited

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Classes meet once per week for 30 minutes. Please choose a time that works the best for you since make-up classes are limited

Enroll in Classes

Select Class

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Exp Year *

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Address Line 1

Address Line 2

City

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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

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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