Salem Swim School Online Registration

Registration

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Welcome to Salem Swim School! Please complete the following membership registration form.
Tuition is billed monthly. The monthly billing amount may vary based on the number of weeks in the calendar month. Tuition is billed on the 1st of the month. A one-time membership fee of $35 per household will be charged when your student(s) are booked in classes. More information is available in the parent portal agreement in "payment 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 # *

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Salem Swim School. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

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 #

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Salem Swim School. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Add Another Student

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Enter your Full Name* June 4, 2026

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Membership Type *

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

Student #2 (Show-Hide Details)

Student #3 (Show-Hide Details)

Student #4 (Show-Hide Details)

Student #5 (Show-Hide Details)

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Required Policies

(Show-Hide Details)