Summer Swim Academy Online Registration

Registration

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Welcome to Summer Swim Academy, we look forward to teaching your child/children this summer! Please complete the following registration form to book lessons for summer 2026! 1) Please put YES for lesson package of choice. (all packages can be shared between siblings) 2) Please add in all students that will be participating in lessons 3) Please provide your preferred availability for lessons each week. If you would like a specific week of M-F, please note your week of preference.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Primary Phone*

Additional Info

10 Lesson Package

15 Lesson Package

20 Lesson Package

30 Lesson Package

40 Lesson Package

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

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Preferred lesson start date?*

Preferred days of the week? *

Times: 9-12? 12-4? or 4-7?*

Preferred # of lessons/week*

Weeks/Days to avoid?(Vacation)*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Preferred lesson start date?*

Preferred days of the week? *

Times: 9-12? 12-4? or 4-7?*

Preferred # of lessons/week*

Weeks/Days to avoid?(Vacation)*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Preferred lesson start date?*

Preferred days of the week? *

Times: 9-12? 12-4? or 4-7?*

Preferred # of lessons/week*

Weeks/Days to avoid?(Vacation)*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Preferred lesson start date?*

Preferred days of the week? *

Times: 9-12? 12-4? or 4-7?*

Preferred # of lessons/week*

Weeks/Days to avoid?(Vacation)*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Preferred lesson start date?*

Preferred days of the week? *

Times: 9-12? 12-4? or 4-7?*

Preferred # of lessons/week*

Weeks/Days to avoid?(Vacation)*

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)

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

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)