Swim Lesson Registration Form
Participant Name: *
Your answer
Sex *
Age: *
Your answer
Date Of Birth: *
MM
/
DD
/
YYYY
Street Address: *
Please include city, state, and zip code.
Your answer
Are you a FOOTHILLS AREA YMCA Member? *
Parent Name(s): *
Your answer
Email: *
Your answer
Phone Number: *
Please provide the best number to reach you at.
Your answer
Medical Conditions/Allergies: *
Your answer
Is your child enrolled in an IEP(individualized Ed. Program) with the local school system? *
If so, are there any accommodations your child requires for swim lessons that we should be aware of?
Your answer
Please Select Program *
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