STAR SWIMMERS
HOME
ABOUT
CONTACT ME
ENROLLMENT
PROGRAMS
INFANT CHILD FAMILY SWIM LESSONS
ADULT & TEEN SWIM
WATER SPORTS & FITNESS
TESTIMONIALS
HOME
ABOUT
CONTACT ME
ENROLLMENT
PROGRAMS
INFANT CHILD FAMILY SWIM LESSONS
ADULT & TEEN SWIM
WATER SPORTS & FITNESS
TESTIMONIALS
Welcome to Star Swimmers! Once you have confirmed and scheduled with Star Swimmers please fill out the enrollment form below:
Enrollment Form
*
Indicates required field
Participant Name
*
First
Last
[object Object]
Parent Name (18 and under)
*
First
Last
[object Object]
Participant Date of Birth
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Please Check Applicable Boxes
*
Is the participant currently seeing a therapist?
Has the participant ever had a seizure?
Is the participant currently prescribed an Epipen?
Has the participant had any surgeries?
Has the participant ever been hospitalized?
Is the participant taking any medications?
Has the participant ever experienced aquatic trauma (drowning/near etc)?drowning)
Has the participant taken swim lessons?
Check here to answer NO to all questions
I agree to receiving marketing and promotional materials
*
Submit
