HEMS Swimming Registration
Please complete all information to help ensure the best placement of your child in our swimming program.
Note: ALL Swimmers MUST be registered on their own sheet - siblings cannot be registered on the same form.
Email address *
Participant Name *
Your answer
Participant Age *
Your answer
Program Registration *
Parent/Guardian Name (if swimmer has a different name than guardian, please indicate both) *
Your answer
Swimmer Birthday *
MM
/
DD
/
YYYY
Address *
Your answer
Email *
Your answer
Phone Number *
Your answer
Preferred Time of Lessons (this is not a guarantee) Please indicate conflicting schedules at time of registration. If your time cannot be accommodated, your registration will be refunded.
How many swimmers are you registering this term? (Please remember that each swimmer needs their registration form.) *
Payment Method *
Paypal (via website)
cash (due before week 1)
Row 1
Are you requesting private or semi-private lessons (note that these are available only if we have adequate pool space & instructors)
Any special requests (please note that we cannot guarantee these - but we do try)
Your answer
A copy of your responses will be emailed to the address you provided.
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