HEMS Swimming Registration
Please complete all information to help ensure the best placement of your child in our swimming program.
Email address *
Participant Name *
Your answer
Participant Age *
Your answer
Program Registration *
Parent/Guardian Name *
Your answer
Address *
Your answer
Email *
Your answer
Phone Number *
Your answer
Preferred Time of Lessons (this is not a guarantee)
How many swimmers are you registering *
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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