Barron Swim School- O'Fallon Online Registration

Registration

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NOTE: This registration form may not work with Windows Explorer browser, please use Chrome, Firefox or Safari! Welcome to Barron Swim School in O'Fallon, MO! Please complete the following registration form. You will receive an email from us very soon with more information. New students may start at anytime. Your registration will become active upon receipt. IF YOU ARE ALREADY A CUSTOMER PLEASE CLICK THE LINK ABOVE. Please call (636)-542-8551 if you have any questions.

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Referral Information

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Home Address*

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Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Health Insurance Carrier*

Promotional Code

Gift Certificate # and Amount

Contact #1

Contact #1 First Name*

Last Name *

Type*

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Home Phone

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Contact #2

Contact #2 First Name

Last Name

Type

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Home Phone

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Student #1

Student's First Name*

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Birth Date*

Additional Info

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Choose your session and specific level that was given to your child through the level finder when searching for a class. Choose session and program when searching for events.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Choose your session and specific level that was given to your child through the level finder when searching for a class. Choose session and program when searching for events.

Enroll in Classes

Select Class

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Student's First Name*

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Additional Info

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Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Choose your session and specific level that was given to your child through the level finder when searching for a class. Choose session and program when searching for events.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Choose your session and specific level that was given to your child through the level finder when searching for a class. Choose session and program when searching for events.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Choose your session and specific level that was given to your child through the level finder when searching for a class. Choose session and program when searching for events.

Enroll in Classes

Select Class

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Exp Year *

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Address Line 2

City

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Zip*

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

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Contact #2

How can we contact you?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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