Sea Monkeys Swimming Online Registration

Registration

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Welcome to Sea Monkeys Swimming! Located in the Pacific Palisades, we strive to make learning to swim a fun experience. Advance swimming skills with world class instructors. Please complete the following registration form to sign up and see our current availability. Weekly lessons. Monthly billing. Note: There are some months that will have 5 classes instead of 4, with billing scaled accordingly.

* denotes required fields

Referral Information

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Postal Code*

Primary Phone*

Additional Info

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

Previous swimming lessons?*

Goals to work towards*

Challenge level (1-5)*

How did you hear about us?*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

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?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Postal Code*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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

Enroll in Classes

Student #2 (Show-Hide Details)

Enroll in Classes

Student #3 (Show-Hide Details)

Enroll in Classes

Student #4 (Show-Hide Details)

Enroll in Classes

Student #5 (Show-Hide Details)

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)