Child's Name *

Child's Age*

Parent's Name *

Member Number*

Preferred email for all communication*

Emergency Contact Number *

Choose session(s) you would like to register for?
June 5th-15th 9:30-10:00am
June 5th-15th 10:00-10:30am
June 19th-29th 9:30-10:00am
June 19th-29th 10:00-10:30am
July 10th-20th 9:30-10:00am
July 10th-20th 10:00am-10:30am

Please describe your child's swimming ability:*