Annual Registration - Super Swimmers Academy

Please enter your information here and then submit your annual registration fee separately. An account will be created for you and then in future years, you can simply confirm your information.

Membership Level

You have selected the Annual Registration membership level.

The price for membership is $0.00 now.

Membership expires after 12 Months.

Account Information Already have an account? Log in here

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

Swimmer Information

Swimmer 1 NAME (First, Last)

Swimmer 1 DOB

Swimmer 1 AGE

Swimmer 1 EXPERIENCE IN WATER

Swimmer 2 NAME (First, Last)

Swimmer 2 DOB

Swimmer 2 AGE

Swimmer 2 EXPERIENCE IN WATER

Swimmer 3 NAME (First, Last)

Swimmer 3 DOB

Swimmer 3 AGE

Swimmer 3 EXPERIENCE IN WATER

Swimmer 4 NAME (First, Last)

Swimmer 4 DOB

Swimmer 4 AGE

Swimmer 4 EXPERIENCE IN WATER

Family Contact Info

Parent/ Guardian Name(s)

Cell Phone

Home Phone

Preferred Call Method

Home

Cell

How did you hear about Super Swimmers Academy?

Emergency Contact Info

Emergency Contact Name

Relationship

Phone

Mailing Address

Instructional Information

Please specify for each swimmer: a) How my child learns best; b) Instructional modifications; c) Fears or prior scary experiences that may affect child's swim lesson. All information is confidential.

Swimmer 1

Swimmer 2

Swimmer 3

Swimmer 4

Emergency Medical Information

For each swimmer, please list any serious illness, injury, operation or disability which would require instructional modifications and or special attention; Allergies that may require immediate attention (allergy to bee stings).

Swimmer 1 Medical Info

Swimmer 2 Medical Info

Swimmer 3 Medical Info

Swimmer 4 Medical Info

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