Pre-Registration for the Splash Swim School Program

Parent or Guardian Information:

Ms. or Mr. (select one) *

Ms.
Mr.

First Name *

Last Name *

Address *

Home Phone *

Cell Phone *

Email (we will keep your email completely private) *

What is your location preference? *

How did you hear about us?

Student Information:

Student #1 First Name *

Student #1 Last Name *

Student #1 Date of Birth *

Student #1 Male or Female? *

Male
Female

What days do you prefer for Student #1? Check all that apply. *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What time of day do you prefer for Student #1? Check all that apply. *

8:00 AM - 12:00 PM
12:00 PM - 4:00 PM
4:00 PM - 7:00 PM
4:00 PM - 7:00 PM and Weekends

Registration Status: Is Student #1 New or Returning? *

New
Returning

For NEW Student #1, please check all that apply:

Has Returning Student #1 had any lessons or participated on swim team since their last class at Splash?

Yes
No

If you answered yes for student #1 having lessons or swim team experience, please indicate where:

Do you need to register a second student?

Yes
No

Student #2 First Name

Student #2 Last Name

Student #2 Date of Birth

Student #2 Male or Female?

Male
Female

What days do you prefer for Student #2? Check all that apply.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What time of day do you prefer for Student #2? Check all that apply.

8:00 AM - 12:00 PM
12:00 PM - 4:00 PM
4:00 PM - 7:00 PM
4:00 PM - 7:00 PM and Weekends

Registration Status: Is Student #2 New or Returning?

New
Returning

For NEW Student #2, please check all that apply:

Has Returning Student #2 had any lessons or participated on swim team since their last class at Splash?

Yes
No

If you answered yes for student #2 having lessons or swim team experience, please indicate where:

Do you need to register a third student?

Yes
No

Student #3 First Name

Student #3 Last Name

Student #3 Date of Birth

Student #3 Male or Female?

Male
Female

What days do you prefer for Student #3? Check all that apply.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What time of day do you prefer for Student #3? Check all that apply.

8:00 AM - 12:00 PM
12:00 PM - 4:00 PM
4:00 PM - 7:00 PM
4:00 PM - 7:00 PM and Weekends

Registration Status: Is Student #3 New or Returning?

New
Returning

For NEW Student #3, please check all that apply:

Has Returning Student #3 had any lessons or participated on swim team since their last class at Splash?

Yes
No

If you answered yes for student #3 having lessons or swim team experience, please indicate where:

Comments, or let us know if you have more children to pre-register, our office will give you a call.

Click the button below to submit your Pre-Registration information to Splash Swim School!

Pre-Registration

Pre-Registration Form

Parent or Guardian Information:

Student Information:

Get Started with Swimming Lessons Today at Splash Swim School