Junior Swim Program Session 3 Registration Request  
This program runs from January 5 - February 13, 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.
Sign in to Google to save your progress. Learn more
Email *
Clear selection
Parent's Name *
Primary Phone Number *
Email *
Address, City, State, Zip Code *
Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
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. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wayside Athletic Club. Report Abuse
Google Forms