Splash Class Middle Georgia Online Registration

Registration

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Welcome to Splash Class Middle Georgia! We've made enrolling your swimmers easy and convenient! Please complete the following registration form to make a big splash this summer! *Please agree to all waivers, this is required for class participation *If you are registering BEFORE choosing a class, please fill out and save your credit card info in the registration form. This will make class selection faster and more efficient!

* 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

I need backtoback classes for

I need same classes for:

I can come at any time: Y/N

I need class later than___ PM:

I need class earlier than _PM:

Contact #1

Contact #1 First Name*

Last Name *

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*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Level Desired 2025*

Independent swimmer? Y/N*

Fearful of water? Y/N*

Experienced/Confident Y/N*

1st time in swim lessons? Y/N*

Class Selection begins February 1st!!

Please click on the Search button below, then choose the class. Classes can be filtered by class offering (Life guarding, May refresher, or summer swim lessons), and also by swim level or swim ability.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Level Desired 2025*

Independent swimmer? Y/N*

Fearful of water? Y/N*

Experienced/Confident Y/N*

1st time in swim lessons? Y/N*

Class Selection begins February 1st!!

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Level Desired 2025*

Independent swimmer? Y/N*

Fearful of water? Y/N*

Experienced/Confident Y/N*

1st time in swim lessons? Y/N*

Class Selection begins February 1st!!

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Level Desired 2025*

Independent swimmer? Y/N*

Fearful of water? Y/N*

Experienced/Confident Y/N*

1st time in swim lessons? Y/N*

Class Selection begins February 1st!!

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Swim Level Desired 2025*

Independent swimmer? Y/N*

Fearful of water? Y/N*

Experienced/Confident Y/N*

1st time in swim lessons? Y/N*

Class Selection begins February 1st!!

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)