Thank you for choosing SwimNOVA Lessons! Please complete the registration form and note that classes are added manually and won't be visible in your parent portal right away.

"A SKILLED SWIMMER IS A SAFER SWIMMER"

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Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State* AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNENCNDNHNJNMNYNVOHOKORPARISCSDTNTXUTVAVTWAWIWVWYPRVI

Zip*

Primary Phone*

Additional Info

Summer League Team Name

Contact #1

Contact #1 First Name*

Last Name *

Type* CaregiverFatherGuardianMotherParentSelf

How Can We Contact You?

Home Phone

Work #

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

Contact #2

Contact #2 First Name

Last Name

Type CaregiverFatherGuardianMotherParentSelf

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Level* New

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Summer League Team Name

Student #2  (Show-Hide Details)

Student's First Name*

Last Name*

Level* New

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Summer League Team Name

Student #3  (Show-Hide Details)

Student's First Name*

Last Name*

Level* New

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Summer League Team Name

Student #4  (Show-Hide Details)

Student's First Name*

Last Name*

Level* New

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Summer League Team Name

Student #5  (Show-Hide Details)

Student's First Name*

Last Name*

Level* New

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Summer League Team Name

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Enter your Full Name* April 25, 2024

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City

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Zip*

eCheck/Bank Draft

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Account Type CheckingSavings

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number