Safe Swim Academy Online Registration

Registration

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Welcome to Safe Swim Academy! Please complete the following registration form.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Account/Family Last Name*

Where do you live?

City*

Zip*

Primary Phone*

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 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*

If we have already scheduled the swim lessons over the phone, please disregard the "Select Class" button. Proceed to the "Required Policies" and hit the submit registration below.

If we haven't scheduled the lessons yet, please contact us at 619-709-3335 for more information and availability. We are happy to help!

We are looking forward to meeting you!

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If we have already scheduled the swim lessons over the phone, please disregard the "Select Class" button. Proceed to the "Required Policies" and hit the submit registration below.

If we haven't scheduled the lessons yet, please contact us at 619-709-3335 for more information and availability. We are happy to help!

We are looking forward to meeting you!

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If we have already scheduled the swim lessons over the phone, please disregard the "Select Class" button. Proceed to the "Required Policies" and hit the submit registration below.

If we haven't scheduled the lessons yet, please contact us at 619-709-3335 for more information and availability. We are happy to help!

We are looking forward to meeting you!

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If we have already scheduled the swim lessons over the phone, please disregard the "Select Class" button. Proceed to the "Required Policies" and hit the submit registration below.

If we haven't scheduled the lessons yet, please contact us at 619-709-3335 for more information and availability. We are happy to help!

We are looking forward to meeting you!

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If we have already scheduled the swim lessons over the phone, please disregard the "Select Class" button. Proceed to the "Required Policies" and hit the submit registration below.

If we haven't scheduled the lessons yet, please contact us at 619-709-3335 for more information and availability. We are happy to help!

We are looking forward to meeting you!

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Referral Information

Family Information

Where do you live?

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

Required Policies

(Show-Hide Details)