Meraquas Class Registration and Liability Waiver
Please fill out the class registration and liability waiver before attending the first class.
Email address *
Swimmer Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Primary Parent/Guardian Name *
Your answer
Home address *
Your answer
City *
Your answer
Zip *
Your answer
Cell Phone #1 *
Your answer
Additional # where we may reach a parent/guardian
Your answer
Email address #1 *
Your answer
What day would you like to schedule your trial class? Generally every Mon and Fri. 5:30-7pm *
MM
/
DD
/
YYYY
If you would like translation assistance please indicate your preferred language.
Your answer
How did you hear about us? *
Required
Anything you would like coaches to know about your child?
Your answer
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