Swim Kids Waco Online Registration

Registration

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Welcome to Swim Waco! We're excited to partner with you to create safe & fun memories around the water.

* 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 Name and Phone Number (Not Contact #1 or #2)*

Coupon Code

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Cell #

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Swim Kids Waco. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Work #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

What are your goals for your child?

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Has your child had a traumatic water incident?

Any prior experience?

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

What are your goals for your child?

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Has your child had a traumatic water incident?

Any prior experience?

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

What are your goals for your child?

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Has your child had a traumatic water incident?

Any prior experience?

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

What are your goals for your child?

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Has your child had a traumatic water incident?

Any prior experience?

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

What are your goals for your child?

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Has your child had a traumatic water incident?

Any prior experience?

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)

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)