Splash! Swim and Wellness Online Registration

Registration

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Welcome to SPLASH! Swim + Wellness! When all required fields are filled out completely, you will be redirected to your Parent Portal, where you can view the schedule and register. If you have any questions, please give us a call at 262-512-7946 and we would be happy to assist!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

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

Student's First Name*

Last Name*

Gender

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

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?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Student #2 (Show-Hide Details)

Student #3 (Show-Hide Details)

Student #4 (Show-Hide Details)

Student #5 (Show-Hide Details)

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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