Patriot Aquatics Online Registration

Registration

Already a customer? Click here to login.

Welcome! Please complete the following registration form. Participated in our programs last year? Click the button above to access your account.

*All discounts (multi-children or multi-week) will be applied at checkout in the parent portal. Please log into your new parent portal account to finalize your registration after completing this form. No payment will be run until you login to your parent portal, verify your class selection(s), and submit the payment.

* 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*

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

Contact #2

First Name

Last Name

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

Please click on the "select class" button below to register! Use the filter button on the top left of the classes window (the blue box with the microscope) to narrow down your search by program, location, etc.

If you are looking for summer swim league, use the filter button and click programs > LBAC Summer Swim League.

If you are looking for splash camp, use the filter button and click programs > Splash Camp.

If you are looking for lessons, use the filter button and click programs > LBAC Swim Lessons OR Westmonte Swim Lessons (depending on which location you are looking for).

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

If you are looking for summer swim league, use the filter button and click programs > LBAC Summer Swim League.

If you are looking for splash camp, use the filter button and click programs > Splash Camp.

If you are looking for lessons, use the filter button and click programs > LBAC Swim Lessons OR Westmonte Swim Lessons (depending on which location you are looking for).

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

If you are looking for summer swim league, use the filter button and click programs > LBAC Summer Swim League.

If you are looking for splash camp, use the filter button and click programs > Splash Camp.

If you are looking for lessons, use the filter button and click programs > LBAC Swim Lessons OR Westmonte Swim Lessons (depending on which location you are looking for).

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

If you are looking for summer swim league, use the filter button and click programs > LBAC Summer Swim League.

If you are looking for splash camp, use the filter button and click programs > Splash Camp.

If you are looking for lessons, use the filter button and click programs > LBAC Swim Lessons OR Westmonte Swim Lessons (depending on which location you are looking for).

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

If you are looking for summer swim league, use the filter button and click programs > LBAC Summer Swim League.

If you are looking for splash camp, use the filter button and click programs > Splash Camp.

If you are looking for lessons, use the filter button and click programs > LBAC Swim Lessons OR Westmonte Swim Lessons (depending on which location you are looking for).

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?

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

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)