Registration
Already a customer? Click here to login.
One-time registration. Takes a few mins.
*
denotes required fields
Referral Information
How did you hear about us?
*
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
*
Where do you live?
Home Address
*
City
*
State
*
Postcode
*
Primary Phone
*
Additional Info
Referring friend's name?
Promo code?
CAR REGISTRATION ( for access)
*
Contact #1
Your First Name
*
Last Name
*
How Can We Contact You?
Cell #
*
Receive Text Message Notifications
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
*
Female
Male
Birth Date
*
(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
*
Swim Ability (beginner etc)
*
Student #2
(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 #3
(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 #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
*
Female
Male
Birth Date
*
(format=dd/mm/yyyy)
Additional Info
Medications (N/A if NONE)
*
Swim Ability (beginner etc)
*
Add Another Student
Required Policies
(Show-Hide Details)
I Agree to All of the Above
Enter your Full Name
*
Questions or Concerns
Comments
