The Aqua Life Swim Academy Online Registration

Registration

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Welcome to The Aqua Life Swim Academy Online Registration Page! Kindly provide your information below and click Submit when complete. You will only need to register once. All monthly billed classes will start upon registration. There are no future enrolments allowed.

* 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/Prov*

Postal Code*

Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 First Name*

Last Name *

Specify*

How Can We Contact You?

Home Phone

Work #

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

Specify

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs/Limitations

Medication/Allergies

Medications

Immunization Notes

Aquatic Goals*

Swim Experience

After you have reviewed the different swim levels and found a time that works best for you, please choose a class:

***All monthly billed classes will start upon registration. There are no future enrolments allowed.***

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs/Limitations

Medication/Allergies

Medications

Immunization Notes

Aquatic Goals*

Swim Experience

After you have reviewed the different swim levels and found a time that works best for you, please choose a class:

***All monthly billed classes will start upon registration. There are no future enrolments allowed.***

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs/Limitations

Medication/Allergies

Medications

Immunization Notes

Aquatic Goals*

Swim Experience

After you have reviewed the different swim levels and found a time that works best for you, please choose a class:

***All monthly billed classes will start upon registration. There are no future enrolments allowed.***

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs/Limitations

Medication/Allergies

Medications

Immunization Notes

Aquatic Goals*

Swim Experience

After you have reviewed the different swim levels and found a time that works best for you, please choose a class:

***All monthly billed classes will start upon registration. There are no future enrolments allowed.***

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs/Limitations

Medication/Allergies

Medications

Immunization Notes

Aquatic Goals*

Swim Experience

After you have reviewed the different swim levels and found a time that works best for you, please choose a class:

***All monthly billed classes will start upon registration. There are no future enrolments allowed.***

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

Country *

City

State/Prov*

Postal Code*

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)