Splash! Swim and Wellness Online Registration

Registration

Already a customer? Click here to login.

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*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Enter Promo Code

Contact #1

First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Splash! Swim and Wellness. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Splash! Swim and Wellness. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Swimming skills/experience (helps us find the right Level):

Once you have filled in all of your registration information and are ready to sign up for classes, please refer to this page to determine your child's level: https://www.splashmequon.com/level-finder/ If you need help at any time, please call us at 262-512-7946.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Swimming skills/experience (helps us find the right Level):

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Swimming skills/experience (helps us find the right Level):

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Swimming skills/experience (helps us find the right Level):

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Swimming skills/experience (helps us find the right Level):

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

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?

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

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)