Lifesaver Aquatics Online Registration

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Primary Doctor

Immunizations YN

Immunization Notes

Small Diaper (16-24 Lbs.)

Medium Diaper (22-30 Lbs)

Large Diaper (28-34 Lbs)

Extra Large Diaper (32-40 Lbs.

2X Large Diaper (38-46 Lbs.)

Please click on the Search button below, then choose the class session you would like to enroll in. Each session is set up as follows.

Sessions run for 6 consecutive weeks Monday-Thursday. The time slot you select will be locked in as yours for that 6 week session. Ex: You select the 10:20-10:30am slot and that will be your swim lesson time for the next 6 weeks.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Primary Doctor

Immunizations YN

Immunization Notes

Small Diaper (16-24 Lbs.)

Medium Diaper (22-30 Lbs)

Large Diaper (28-34 Lbs)

Extra Large Diaper (32-40 Lbs.

2X Large Diaper (38-46 Lbs.)

Please click on the Search button below, then choose the class session you would like to enroll in. Each session is set up as follows.

Sessions run for 6 consecutive weeks Monday-Thursday. The time slot you select will be locked in as yours for that 6 week session. Ex: You select the 10:20-10:30am slot and that will be your swim lesson time for the next 6 weeks.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Primary Doctor

Immunizations YN

Immunization Notes

Small Diaper (16-24 Lbs.)

Medium Diaper (22-30 Lbs)

Large Diaper (28-34 Lbs)

Extra Large Diaper (32-40 Lbs.

2X Large Diaper (38-46 Lbs.)

Please click on the Search button below, then choose the class session you would like to enroll in. Each session is set up as follows.

Sessions run for 6 consecutive weeks Monday-Thursday. The time slot you select will be locked in as yours for that 6 week session. Ex: You select the 10:20-10:30am slot and that will be your swim lesson time for the next 6 weeks.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Primary Doctor

Immunizations YN

Immunization Notes

Small Diaper (16-24 Lbs.)

Medium Diaper (22-30 Lbs)

Large Diaper (28-34 Lbs)

Extra Large Diaper (32-40 Lbs.

2X Large Diaper (38-46 Lbs.)

Please click on the Search button below, then choose the class session you would like to enroll in. Each session is set up as follows.

Sessions run for 6 consecutive weeks Monday-Thursday. The time slot you select will be locked in as yours for that 6 week session. Ex: You select the 10:20-10:30am slot and that will be your swim lesson time for the next 6 weeks.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Primary Doctor

Immunizations YN

Immunization Notes

Small Diaper (16-24 Lbs.)

Medium Diaper (22-30 Lbs)

Large Diaper (28-34 Lbs)

Extra Large Diaper (32-40 Lbs.

2X Large Diaper (38-46 Lbs.)

Please click on the Search button below, then choose the class session you would like to enroll in. Each session is set up as follows.

Sessions run for 6 consecutive weeks Monday-Thursday. The time slot you select will be locked in as yours for that 6 week session. Ex: You select the 10:20-10:30am slot and that will be your swim lesson time for the next 6 weeks.

Enroll in Classes

Select Class

Registration

Welcome to Lifesaver Aquatics! Please complete the following registration form. To register, fill out required documents and then visit the parent portal. In Parent Portal select class and pay fees. Registration is not completed until fees are paid.

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

Account Information

Registration

Welcome to Lifesaver Aquatics! Please complete the following registration form. To register, fill out required documents and then visit the parent portal. In Parent Portal select class and pay fees. Registration is not completed until fees are paid.

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

Account Information

Required Policies

(Show-Hide Details)