Back to Basics Swim Academy Online Registration

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We'll get you into the swim of things!

You can JOIN US at any point during a session. We will pro-rate for missed classes.

SWIM Lessons: We offer PRIVATE (1:1) and SEMI-PRIVATE (2:1)

LEADERSHIP courses: Group setting and dates/fees are as posted

Payment is due once invoice is received
Options: EMT/Cash/CC
EMT (auto-deposit): info@learn2swim.ca

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Postal Code*

Contact #1

First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

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?

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Experience*

Swim Program(s) Attended

Class Ratio: Private or Semi *

Time Preference*

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Experience*

Swim Program(s) Attended

Class Ratio: Private or Semi *

Time Preference*

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Experience*

Swim Program(s) Attended

Class Ratio: Private or Semi *

Time Preference*

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Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Experience*

Swim Program(s) Attended

Class Ratio: Private or Semi *

Time Preference*

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Experience*

Swim Program(s) Attended

Class Ratio: Private or Semi *

Time Preference*

Enroll in Classes

Select Class

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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

Additional Info

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Student #3 (Show-Hide Details)

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