Swim Team January 2021 Registration Request
This program runs from January 4 - January 28, 2021

Registration requests will be reviewed and processed in the order in which they are received. You will be contacted to confirm the registration and to make payment for the program.
Email address *
Parent's Name *
Primary Phone Number *
Email *
Address, City, State, Zip Code *
Child's Name *
Date of Birth *
Child's Age *
Gender *
Are you a member? *
Member Number
Class Name *
Class Fee *
By submitting this form, I agree to the terms and conditions of the Membership Agreement and Policies available at: https://bit.ly/MembAgmt and https://bit.ly/RefundWaiverPolicy. *
Never submit passwords through Google Forms.
This form was created inside of Wayside Athletic Club. Report Abuse