Registration Form Parent Name * First Name Last Name Email * Phone * (###) ### #### How many kids will be attending the lesson? One Two Three Four or More Student Name * Age * Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+ Additional Student's Name Age None Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+ Additional Student's Name Age None Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+ How did you here about us? Instagram Friend Other Referral If someone referred you to us, please let us know who. Type of lessons you are interested in * Parent and ME (6month-2yrs) Learn to Swim (2yrs and up) Competitive Swim Adult Classes Mix Classes(ex:Learn-to-Swim and Parent and ME) Semi-Private Group Lessons Lesson Package * How many lessons would you like to purchase? *Please look at the swim packages available before selecting the number of lessons.* 1 Lesson 2 Lessons 3 Lessons 4 Lessons 5 Lessons 6 Lessons 12 Lessons 18 Lessons Mintues per lesson * How long do you want your child/children to have lessons for? 30 Minutes 45 Minutes 60 Minutes 90 Minutes 120 Minutes How many lessons would you like to have per week? 1 2 3 Undecided Days available for lessons * Saturday times are from 9am-11am Monday Tuesday Wednesday Thursday Friday Saturday Sunday Times you are availiable * The times that you pick may not be avaliable so please try and pick all times that will work for you. 7am-9am 9am-11am 11am-1pm 1pm-3pm 3pm-5pm 5pm-7pm Address of Pool * Address 1 Address 2 City State/Province Zip/Postal Code Country Additional Information * Please give us a brief explanation of how your child is in the water. (Example: My child is comfortable in the water but doesn't like to put his head under.) * I have read and agree to the Liability Release, Assumption of Risk, and Policies. Yes Electronic Signature The Swim Lessons Agreement is an electronic contract that governs your use of and access to the Ohana Swim Academy LLC website and services. Upon agreeing to the Swim Lessons Agreement when completing the swim lessons registration form, you acknowledge that you understand and agree to be legally bound by the Swim Lessons Agreement and the terms, conditions, and notices contained or referenced herein. Checking the box creates an electronic signature with the same legal force and effect as a handwritten signature. Type your First and Last name. Thank you for submitting your registration! You will be contacted ASAP to schedule lessons.