Fall 2017 Program Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Your registration will be confirmed via email or phone call by Alexus as space is very limited.

Parent or Guardian First and Last Name

Email *

Phone Number *

Student's First Name *

Please fill out one registration form per individual

Student's Last Name *

Please fill out one registration form per individual

Student's Age *

Pleas fill out one form per individual

Choose which program you are wishing to register for *

How are you afflilated with our program. *

Have you been in our program before? *

(Specifically at the Andrews Beaty Pool)

Yes

Required

Electronic Signature: Videography/ Photo Image Release *

I grant permission to Andrews University Beaty Pool to use photo or video images of my child as well as my child’s name as part of Beaty Pool public marketing campaigns, including print media, broadcast media, and Andrews University website.

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms