Blue Dolphins Aquatics, LLC Online Registration

Registration

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This registration form contains agreements to be signed by the legal guardian of minor students - please do not complete this form unless you are the student's legal guardian or an adult student signing for yourself.

Please do NOT create an account unless you have received an email directly from Blue Dolphins Aquatics with directions to request lessons or enroll in swim team.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family (Student) Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Subdivision*

County of residence*

Contact #1

Primary (Communication & Billing) Contact - First Name*

Last Name *

Relationship to student*

How Can We Contact You?

Home Phone

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Secondary Contact (opted-out of mass email by default) - First Name*

Last Name*

Relationship to student*

How can we contact you?

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Email for Lifeguard Students ONLY

May we use this swimmers' photo on BDA website/publications?*

Medical Concerns / Special Needs

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Email for Lifeguard Students ONLY

May we use this swimmers' photo on BDA website/publications?*

Medical Concerns / Special Needs

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Email for Lifeguard Students ONLY

May we use this swimmers' photo on BDA website/publications?*

Medical Concerns / Special Needs

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Email for Lifeguard Students ONLY

May we use this swimmers' photo on BDA website/publications?*

Medical Concerns / Special Needs

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Email for Lifeguard Students ONLY

May we use this swimmers' photo on BDA website/publications?*

Medical Concerns / Special Needs

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

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)