Suzie's Swim LLC Online Registration

Registration

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Welcome to Suzie's Swim LLC! Please complete the following registration form. If you are with Emerging Minds Montessori School Camp please notate that in the class selection!

* 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 *

Preferred Days*

Preferred Times*

Preferred Language*

Contact #1

Parent/Guardian #1 First Name*

Last Name *

Relationship to Swimmer*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Parent/Guardian #2 First Name

Last Name

Relationship to Swimmer

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

Does the swimmer have separation or stranger anxieties?

What class type are you interested in joining?*

Have they ever had lessons before?

How comfortable is your child in the water? Do they have a fear of the water?

What are your lesson goals?

Please list any disabilities or special needs we need to be aware of

Please list any medical history that we should be aware of that would aid us during our classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Does the swimmer have separation or stranger anxieties?

What class type are you interested in joining?*

Have they ever had lessons before?

How comfortable is your child in the water? Do they have a fear of the water?

What are your lesson goals?

Please list any disabilities or special needs we need to be aware of

Please list any medical history that we should be aware of that would aid us during our classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Does the swimmer have separation or stranger anxieties?

What class type are you interested in joining?*

Have they ever had lessons before?

How comfortable is your child in the water? Do they have a fear of the water?

What are your lesson goals?

Please list any disabilities or special needs we need to be aware of

Please list any medical history that we should be aware of that would aid us during our classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Does the swimmer have separation or stranger anxieties?

What class type are you interested in joining?*

Have they ever had lessons before?

How comfortable is your child in the water? Do they have a fear of the water?

What are your lesson goals?

Please list any disabilities or special needs we need to be aware of

Please list any medical history that we should be aware of that would aid us during our classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Does the swimmer have separation or stranger anxieties?

What class type are you interested in joining?*

Have they ever had lessons before?

How comfortable is your child in the water? Do they have a fear of the water?

What are your lesson goals?

Please list any disabilities or special needs we need to be aware of

Please list any medical history that we should be aware of that would aid us during our classes

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

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

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

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Required Policies

(Show-Hide Details)