One with the Water, a 501(c)(3) non-profit

Online Registration

Step 1 of 3

Biographical

Waiver

Fees

Payment

Instructions: To become a One with the Water® member, please complete this registration form. Services provided at all locations and pricing will be listed on the Shopping Cart page.

Please input the swimmer's information. Swim session dates, times, goals and type of class will be discussed with our Scheduling Coordinator after you have completed the registration process. On the billing page, you will be asked for your payment information. We accept Visa, MasterCard, American Express, and Discover credit cards.

Your card will not be charged after you submit your information; it will be charged after we have scheduled your lessons. See our website for current public pool schedules.

SWIMMER INFORMATION:

* Starred fields are required

First Name *
Preferred (Nickname)
Middle Name
Last Name *
Create Password

Sex * Female Male

Birth Date * (mm/dd/yyyy)

Phones

Home *
Work
Cell *

Email *		Label
Email		Label
Email		Label
Email		Label
Email		Label
Email		Label

Add Another Email Address

Street *
Street 2
City *
State *
ZIP *

Emergency Contact (Parent, Spouse, etc)
Name *		Relation
Phone *
Name 2 *		Relation 2
Phone 2 *

Does the swimmer have any allergies? *

(Bee stings, foods, medicine, etc.)

Any pertinent medical history we should know about? *

(None, List Allergies, Required Accommodations, etc.)

How did you hear about us? Comments?

(Google, Yelp, Friend, Doctor, etc.)

What is your preferred pool?

My child meets the requirements for special accommodations.

I agree and have read the Special Accommodations explanation. *Required for lessons in Santa Monica.

(https://onewiththewater.org/santa-monica/special-needs-faq/#define)

CANCELLATION POLICY - Please make every effort to attend all lessons. Pool space, insurance & instructors are booked 1 month in advance. Refunds are not issued for missed lessons. We can convert missed lessons into a tax-deductible donation. *

I agree and have read the Cancellation Policy.

Problem with this registration?