RIVERSIDE AQUETTES SWIM CLUB Online Registration

Registration

Already a customer? Click here to login.

Welcome to RAQ! Please read and complete the following pre-registration form. You will be signing up your child to take a swim placement test before you can register for the artistic or swim teams. RETURNING PARENTS: Please fill out this form to create your sign-on for the parent portal. To sign up for PRIVATE LESSONS, current members can do this in the parent portal under Events not Classes. NEW PARENTS should go directly to Swimraq.org - Programs - Private Lessons to register

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

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

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Previous swim team (Y/N)?*

Previous swim lessons (Y/N)?*

Have you done gymnastics (Y/N?*

Have you been in dance (Y/N)?*

Photo Release Y/N ?*

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Previous swim team (Y/N)?*

Previous swim lessons (Y/N)?*

Have you done gymnastics (Y/N?*

Have you been in dance (Y/N)?*

Photo Release Y/N ?*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Previous swim team (Y/N)?*

Previous swim lessons (Y/N)?*

Have you done gymnastics (Y/N?*

Have you been in dance (Y/N)?*

Photo Release Y/N ?*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Previous swim team (Y/N)?*

Previous swim lessons (Y/N)?*

Have you done gymnastics (Y/N?*

Have you been in dance (Y/N)?*

Photo Release Y/N ?*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Previous swim team (Y/N)?*

Previous swim lessons (Y/N)?*

Have you done gymnastics (Y/N?*

Have you been in dance (Y/N)?*

Photo Release Y/N ?*

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

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

Required Policies

(Show-Hide Details)