Little Flippers Swim Academy 2021 Registration
Please complete the following to indicate interest in being contacted by email for the 2021 summer swim season.  Emails usually go out in April or May.  Returning Students should indicate that in question number three.
 
Please save littleflippersswimacademy@gmail.com in your contacts so our email does not go to Junk Mail.  

You can use this form to register up to 4 children in the same family using Sections 1-4.  You must accept the rules in Section 5 in order to complete registration.  Answering the scheduling questions will help us plan accordingly.
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Email *
Participant I Name:
Date of Birth:
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Has this child taken swimming lessons previously?
If Yes, What Red Cross Level were they in:  (If Not Red Cross - Indicate in "Other"
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If Yes, approximately how long has it been since this student took swim lessons.
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Are there any health concerns the instructor should be aware of (for example diabetes, seizure disorder, etc.)
Parent/Guardian Name:
Home Address: (Street, Apt. #, City, State, Zip
Cellular Phone:
Texting Ok?
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Alternate Phone:
Emergency Contact Name:
Emergency Contact Phone:
What type of lesson instruction are you requesting:
Classes will be offered after school and/or work depending on the instructor and are very limited during the school year.  Please let us know your availability by checking all that apply:
Please further indicate times that will or will not work.  (Which ever is easier.  Ex:  "Available between 4pm and 9pm Mon. Wed and Fri." or "Not available 3-4 pm on Wednedays."
When are you interested in receiving lessons? (Check all that apply)
Please indicate any specific details we should be aware of.  (Example:  "Need lessons to be finished by May for vacation.")
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