Swimmers by Jessica
Registration
Email address *
Child's name: *
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Child's date of birth: YEAR/Month/Date *
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Parent's name: *
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Address: *
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Cell phone number: *
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Email address: *
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Previous swimming experience: *
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Child's physician's name: *
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Physician's phone number: *
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Please list any allergies: *
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Are vaccines up to date? *
Does your child have any special needs or developmental delays that we need to take into account when determining class sizes? *
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