Cardinal Aquatics, LLC Online Registration

Registration

Welcome to Cardinal Aquatics, LLC! We are so excited for you to be here. We are located in Fairfax, Virginia and lessons are at Lakeview Swim Club - 5352 Gainsborough Dr. Class descriptions can be found here: https://lakeview.swimtopia.com/group-lessons Please complete the following registration form below. Questions? Please email cardinal.aquatics03@gmail.com We have a no-refund policy.

* denotes required fields

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*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Contact #2

Contact #2 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)

2024 Lessons are Monday through Friday at 10:15 or 10:45am.

Week 1 June 17-June 21
Week 2 June 24 -June 28
Week 3 July 1 - July 5
Week 4 July 8 - July 12
Week 5 July 15 - July 19

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)

2024 Lessons are Monday through Friday at 10:15 or 10:45am.

Week 1 June 17-June 21
Week 2 June 24 -June 28
Week 3 July 1 - July 5
Week 4 July 8 - July 12
Week 5 July 15 - July 19

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)

2024 Lessons are Monday through Friday at 10:15 or 10:45am.

Week 1 June 17-June 21
Week 2 June 24 -June 28
Week 3 July 1 - July 5
Week 4 July 8 - July 12
Week 5 July 15 - July 19

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)

2024 Lessons are Monday through Friday at 10:15 or 10:45am.

Week 1 June 17-June 21
Week 2 June 24 -June 28
Week 3 July 1 - July 5
Week 4 July 8 - July 12
Week 5 July 15 - July 19

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)

2024 Lessons are Monday through Friday at 10:15 or 10:45am.

Week 1 June 17-June 21
Week 2 June 24 -June 28
Week 3 July 1 - July 5
Week 4 July 8 - July 12
Week 5 July 15 - July 19

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?

Contact #1

How Can We Contact You?

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)