SOUTH SOUND SWIM AND SAFETY Online Registration

Registration

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WELCOME TO SOUTH SOUND SWIM AND SAFETY! Please complete the following registration form to join our program. Group classes are $30 per class. Private classes are $75 per class. Annual Registration Fee $35 for 1 child, 2nd child $15, 3rd child $15

* 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

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 # 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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

How Does Swimmer Best Learn?

Developmental Delays?

Sensory Needs?

Physical Needs?

Language Needs?

Please click on the Search button below, then choose the class. Classes are listed by age group and type of class.

Parent and Child class is for parents and their kids around ages 6 months to 3 years old.

Lane 1: Preschool classes are for kids ages around 2-6 years old. They will be working on putting their face in the water and swim with teacher assistance.

Lane 2: Youth Beginner classes are for kids around ages 5-12 years of age. They will be working on rudimentary skills and swimming 10-15 yards on their own.

Lane 3: Youth Intermediate classes are for kids around 6-13 years old. They will be working on additional strokes and building endurance.

Swim Team Prep is for kids who can swim full laps and build a upon swim skills and advanced skill techniques.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

How Does Swimmer Best Learn?

Developmental Delays?

Sensory Needs?

Physical Needs?

Language Needs?

Please click on the Search button below, then choose the class. Classes are listed by age group and type of class.

Parent and Child class is for parents and their kids around ages 6 months to 3 years old.

Lane 1: Preschool classes are for kids ages around 2-6 years old. They will be working on putting their face in the water and swim with teacher assistance.

Lane 2: Youth Beginner classes are for kids around ages 5-12 years of age. They will be working on rudimentary skills and swimming 10-15 yards on their own.

Lane 3: Youth Intermediate classes are for kids around 6-13 years old. They will be working on additional strokes and building endurance.

Swim Team Prep is for kids who can swim full laps and build a upon swim skills and advanced skill techniques.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

How Does Swimmer Best Learn?

Developmental Delays?

Sensory Needs?

Physical Needs?

Language Needs?

Please click on the Search button below, then choose the class. Classes are listed by age group and type of class.

Parent and Child class is for parents and their kids around ages 6 months to 3 years old.

Lane 1: Preschool classes are for kids ages around 2-6 years old. They will be working on putting their face in the water and swim with teacher assistance.

Lane 2: Youth Beginner classes are for kids around ages 5-12 years of age. They will be working on rudimentary skills and swimming 10-15 yards on their own.

Lane 3: Youth Intermediate classes are for kids around 6-13 years old. They will be working on additional strokes and building endurance.

Swim Team Prep is for kids who can swim full laps and build a upon swim skills and advanced skill techniques.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

How Does Swimmer Best Learn?

Developmental Delays?

Sensory Needs?

Physical Needs?

Language Needs?

Please click on the Search button below, then choose the class. Classes are listed by age group and type of class.

Parent and Child class is for parents and their kids around ages 6 months to 3 years old.

Lane 1: Preschool classes are for kids ages around 2-6 years old. They will be working on putting their face in the water and swim with teacher assistance.

Lane 2: Youth Beginner classes are for kids around ages 5-12 years of age. They will be working on rudimentary skills and swimming 10-15 yards on their own.

Lane 3: Youth Intermediate classes are for kids around 6-13 years old. They will be working on additional strokes and building endurance.

Swim Team Prep is for kids who can swim full laps and build a upon swim skills and advanced skill techniques.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

School

Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

How Does Swimmer Best Learn?

Developmental Delays?

Sensory Needs?

Physical Needs?

Language Needs?

Please click on the Search button below, then choose the class. Classes are listed by age group and type of class.

Parent and Child class is for parents and their kids around ages 6 months to 3 years old.

Lane 1: Preschool classes are for kids ages around 2-6 years old. They will be working on putting their face in the water and swim with teacher assistance.

Lane 2: Youth Beginner classes are for kids around ages 5-12 years of age. They will be working on rudimentary skills and swimming 10-15 yards on their own.

Lane 3: Youth Intermediate classes are for kids around 6-13 years old. They will be working on additional strokes and building endurance.

Swim Team Prep is for kids who can swim full laps and build a upon swim skills and advanced skill techniques.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

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*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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)

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

eCheck/Bank Draft

Required Policies

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