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 parent portal account to submit your registration payment after completing this form. No payment will be run until you login to your parent portal and submit the registration payment after completing this 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*

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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Approved adults(s) for pick up (Required for splash camp ONLY)

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 if you are registering for splash camp or summer league.

NOTE: Swim lessons will NOT be listed below. Please continue to complete the registration form and leave any important information (site location, lesson type, preferred lesson session, preferred lesson time, special needs, etc) in the comments section below. We will contact you directly within 24 business hours to finalize your registration.

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

T-Shirt Size

Approved adults(s) for pick up (Required for splash camp ONLY)

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

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

T-Shirt Size

Approved adults(s) for pick up (Required for splash camp ONLY)

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

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

T-Shirt Size

Approved adults(s) for pick up (Required for splash camp ONLY)

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

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

T-Shirt Size

Approved adults(s) for pick up (Required for splash camp ONLY)

Special Needs (Leave blank if NONE)

Allergies (Required for splash camp ONLY)

Medications Required (Required for splash camp ONLY)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Liability Waiver

I've read the above and agree.

Medical Release Waiver

I've read the above and agree.

Covid-19 Waiver

I've read the above and agree.

Payment Policy

I've read the above and agree.

Photo Release Consent Waiver

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

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 and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)