Swim with Coach Dana Online Registration

Registration

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Welcome to Swim with Coach Dana online registration! For easy steps to lessons - 1) Register your family. 2) Read and agree to the terms and conditions of this contract. 3) To enroll choose location, type , day, time, you're interested in. Use filters to narrow your search. 4) Initiate payment through the Parent Portal. Your access will come via email. With registration you gain access to the Parent Portal. Lots to do there so check it out.

* 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*

Additional Info

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

Who will bring if not parent?

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

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 - Gives Parent Portal Access First Name

Last Name

Type

How can we contact you?

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Previous swimming experience? *

Current Student Swim Skills

1) First decide what location, then the type of lesson you'd like. There are Family Privates where siblings learn together, or Private one-on-one. You customize the schedule. These classes are at varies times and great for all ages. Group classes are also available.

2) Please click on the "Select Class" button below. Sort by "Location" then "Category 1" then click "Start Date" to put in chronological order.

3) Choose available dates and times that work best for you and your family for Privates. REMINDER - minimum 3 classes for Private and Family Private lessons. Choose Group session based on skills level for Coach Dana's pool or Swim School for Patterson Park.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Previous swimming experience? *

Current Student Swim Skills

2) Please click on the "Select Class" button below. Sort by "Location" then "Category 1" then click "Start Date" to put in chronological order.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Previous swimming experience? *

Current Student Swim Skills

2) Please click on the "Select Class" button below. Sort by "Location" then "Category 1" then click "Start Date" to put in chronological order.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Previous swimming experience? *

Current Student Swim Skills

2) Please click on the "Select Class" button below. Sort by "Location" then "Category 1" then click "Start Date" to put in chronological order.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level*

Special Needs (Leave blank if NONE)

Previous swimming experience? *

Current Student Swim Skills

2) Please click on the "Select Class" button below. Sort by "Location" then "Category 1" then click "Start Date" to put in chronological order.

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)