Low Country Swim School Online Registration

Registration

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NOW REGISTERING FOR A SPRING REGISTRATION (SUMMER STARTS APRIL 1ST) CALL FOR AVAILABLE DAYS AND TIMES AT OUR NORTH CHARLESTON AQUATIC LOCATION. BE REMINDED ONCE YOU ARE REGISTRED AND PLACED IN A CLASS YOU ARE CHARGED THE FULL AMOUNT OF PAYMENT. If you have any questions, please email us at lowcountryswim@gmail.com or call 843-981-2885.

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Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

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

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 (Emergency) First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

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)

PLEASE FILL OUT THE LINK BELOW IN ADDITION TO SUBMITTING THIS REGISTRATION FORM

(THE FORM YOU ARE CURRENTLY ON IS FOR BILLING AND PROCESSING AND THE FORM BELOW IS FOR THE CLASSES).

Please Copy and Paste THE LINK INTO ANOTHER SEARCH BAR to fill out additional information so we know what you are looking for.

https://form.jotform.com/220017573710042

Enroll in Classes

Select Class

Student #2 (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)

PLEASE FILL OUT THE LINK BELOW IN ADDITION TO SUBMITTING THIS REGISTRATION FORM

(THE FORM YOU ARE CURRENTLY ON IS FOR BILLING AND PROCESSING AND THE FORM BELOW IS FOR THE CLASSES).

Please Copy and Paste THE LINK INTO ANOTHER SEARCH BAR to fill out additional information so we know what you are looking for.

https://form.jotform.com/220017573710042

Enroll in Classes

Select Class

Student #3 (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)

PLEASE FILL OUT THE LINK BELOW IN ADDITION TO SUBMITTING THIS REGISTRATION FORM

(THE FORM YOU ARE CURRENTLY ON IS FOR BILLING AND PROCESSING AND THE FORM BELOW IS FOR THE CLASSES).

Please Copy and Paste THE LINK INTO ANOTHER SEARCH BAR to fill out additional information so we know what you are looking for.

https://form.jotform.com/220017573710042

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)

PLEASE FILL OUT THE LINK BELOW IN ADDITION TO SUBMITTING THIS REGISTRATION FORM

(THE FORM YOU ARE CURRENTLY ON IS FOR BILLING AND PROCESSING AND THE FORM BELOW IS FOR THE CLASSES).

Please Copy and Paste THE LINK INTO ANOTHER SEARCH BAR to fill out additional information so we know what you are looking for.

https://form.jotform.com/220017573710042

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)

PLEASE FILL OUT THE LINK BELOW IN ADDITION TO SUBMITTING THIS REGISTRATION FORM

(THE FORM YOU ARE CURRENTLY ON IS FOR BILLING AND PROCESSING AND THE FORM BELOW IS FOR THE CLASSES).

Please Copy and Paste THE LINK INTO ANOTHER SEARCH BAR to fill out additional information so we know what you are looking for.

https://form.jotform.com/220017573710042

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)