Swim Lesson Registration Form
This form is used to register swimmers for the Northern TRIBS Swim Lesson Program.
Email address *
Photo of swimmers in Station 1 developing water comfort.
Group Information
Tell us where, when and what group you plan to join
Location *
Session *
Section *
You may enter multiple sections - save $10/section when registering for 3 or more.
Required
Group *
Comments or special requests
Your answer
Swimmer's Information:
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
Date of birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
F - Female or M - Male
Parent/guardian Information
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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