Registration
Already a customer? Click here to login.
One-time registration. Takes a few mins.
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denotes required fields
Referral Information
How did you hear about us?
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Beacon Centre
Facebook
Flyer - In bag
Flyer - shop or pinboard
Flyer - through door
Internet Search
Other
Referral
Returning Family
Website
Word of mouth
Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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Postcode
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Primary Phone
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Additional Info
Referring friend's name?
Promo code?
CAR REGISTRATION ( for access)
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Contact #1
Your First Name
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Last Name
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How Can We Contact You?
Cell #
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Receive Text Message Notifications
Portal Access (your email is your login)
Email
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(Emails are kept confidential)
Confirm Email
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Portal Account Password
Confirm Portal Account Password
Student #1
Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
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Swim Ability (beginner etc)
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Student #2
(Show-Hide Details)
Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
*
(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
*
Swim Ability (beginner etc)
*
Student #3
(Show-Hide Details)
Student's First Name
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Last Name
*
Student Gender
*
Female
Male
Birth Date
*
(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
*
Swim Ability (beginner etc)
*
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
*
Swim Ability (beginner etc)
*
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
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Female
Male
Birth Date
*
(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
*
Swim Ability (beginner etc)
*
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
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Questions or Concerns
Comments