Swim Lesson Registration Form
This form is used to register swimmers for the Northern TRIBS Swim Lesson Program. Year-round locations include Canton JH pool, Massena HS pool, and SUNY Potsdam-Maxcy Hall pool. Swimmers must be age 5-13. Advanced swimmers should join stroke school or another competitive group based on their ability. See Competitive.
Email address *
Photo of swimmers in Station 1 developing water comfort.
Group Information
Tell us where, when and what group your swimmer plans to join.
Location *
Session *
Section *
You may enter multiple sections - save $10/section when registering for 3 or more.
Required
Group *
A1 and A2 is a code we use for M/W or T/TH. Both groups offer the same stations (1-5) and usually the same instructors.
Comments or special requests
Lesson membership is $75/person per section. We offer a $10 discount when registering for 2 or more sections at a time, and then family discounts of 10% for 2, 15% for 3, and 20% for 4 or more kids. We also ave an Outreach Program for families who require assistance. Please leave a comment below for additional membership information.
Your answer
Swimmer's Information:
Participant
Last name *
Must be as appears on swimmer's birth certificate or passport.
Your answer
First name *
Must be as appears on swimmer's birth certificate or passport.
Your answer
Middle initial *
Must be as appears on swimmer's birth certificate or passport.
Your answer
Preferred name (short name)
Other than what appears on swimmer's birth certificate or passport such as Johnny for Johnathan
Your answer
Date of birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
F - Female or M - Male
Parent/guardian Information
Primary caregiver
Name *
Jane and John Doe
Your answer
Address line 1 *
House number and road
Your answer
City *
Town
Your answer
Zip/postal code *
12345
Your answer
Home (cell) phone number *
1234567890
Your answer
A copy of your responses will be emailed to the address you provided.
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