All-Star Academy Swim School Registration Form

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Template Description (not shown in form): All-Star Swim School Registration Form

All-Star Academy Swim School Registration Form

All-Star Registration Information

Full Name: *

(first, last name)

Email:

Cell Phone #: *

( )

Home Phone #: *

( )

Address

Street Address

Address continued

City

Zip

State

Child's Information

Child's Name:

Child's Age:

Birthdate

Previous Lessons

If Yes to Previous Lessons, Where?

I am interested the following Swim Program for this Child:

Choose an Instructor:

Water Experience: Enters Water with No FearsHas Fears of WaterKnowledge of Basic StrokesHas Breathe Control

Child's Information

Child's Name:

Child's Age:

Birthdate

Previous Lessons

If Yes to Previous Lessons, Where?

I am interested the following Swim Program for this Child:

Choose an Instructor:

Water Experience: Enters Water with No FearsHas Fears of WaterKnowledge of Basic StrokesHas Breathe Control

Child's Information

Child's Name:

Child's Age:

Birthdate

Previous Lessons

If Yes to Previous Lessons, Where?

I am interested the following Swim Program for this Child:

Choose an Instructor:

Water Experience: Enters Water with No FearsHas Fears of WaterKnowledge of Basic StrokesHas Breathe Control

Swim Lesson Information

How did you hear us? *

All-Star Academy is a Year-Round Facility: What program are you interested in: *

How many Sessions [4 to 6 Lessons]would you like to secure? *