Penguin City Swim Online Registration

Registration

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Welcome to Penguin City Swim! 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 *

Type

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

To register for a class you will need to enter the type of class and the level of class.

Type of Class (enter into the Type of Class field on the search bar)
Small Group
Semi Private

Water Baby Class

Your Level can be found on https://www.penguincityswim.com/levels

We look forward to seeing you in the water.

Penguin City Swim

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

To register for a class you will need to enter the type of class and the level of class.

Type of Class (enter into the Type of Class field on the search bar)
Small Group
Semi Private

Water Baby Class

Your Level can be found on https://www.penguincityswim.com/levels

We look forward to seeing you in the water.

Penguin City Swim

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

To register for a class you will need to enter the type of class and the level of class.

Type of Class (enter into the Type of Class field on the search bar)
Small Group
Semi Private

Water Baby Class

Your Level can be found on https://www.penguincityswim.com/levels

We look forward to seeing you in the water.

Penguin City Swim

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

To register for a class you will need to enter the type of class and the level of class.

Type of Class (enter into the Type of Class field on the search bar)
Small Group
Semi Private

Water Baby Class

Your Level can be found on https://www.penguincityswim.com/levels

We look forward to seeing you in the water.

Penguin City Swim

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

To register for a class you will need to enter the type of class and the level of class.

Type of Class (enter into the Type of Class field on the search bar)
Small Group
Semi Private

Water Baby Class

Your Level can be found on https://www.penguincityswim.com/levels

We look forward to seeing you in the water.

Penguin City Swim

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

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)

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)