Meadowbrook Swim Club Online Registration

Registration

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Welcome to Meadowbrook Swim Lessons! Please complete the following registration form.

* 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*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

1st Choice Class, Day, & Time*

2nd Choice Class, Day, & Time*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

1st Choice Class, Day, & Time*

2nd Choice Class, Day, & Time*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

1st Choice Class, Day, & Time*

2nd Choice Class, Day, & Time*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

1st Choice Class, Day, & Time*

2nd Choice Class, Day, & Time*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

1st Choice Class, Day, & Time*

2nd Choice Class, Day, & Time*

Add Another Student

Required Policies and Agreements

Meadowbrook Swim Lesson Policies

* Thank you for being part of the Meadowbrook Swimming Family!!!
* All our lessons are 40 minutes in length.
* Group Lessons and Stroke & Turn will be charged when enrolled.
* Students should make every effort to attend classes as scheduled. There is NO OPPORTUNITY to make-up.
* Make-ups are for inclement weather or unforeseen cancellations on the part of Meadowbrook ONLY.
* Parents-please allow us to work with your child independently without coming onto the pool deck.
* Semi-private lessons ($58)must be arranged by student families. If only one student shows up for the lessons it will be billed as a Private $40.
*Private Lessons are pay-as-go. You will be charged after the lesson takes place.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

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*