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

Online Registration

Step 1 of 3
Biographical Waiver Payment Receipt
Please provide the swimmer's information below in order to complete your request. Swim session dates and times, and type of class will be discussed with our Scheduling Coordinator.
Instructions  To become a One with the Water® member, please complete this 2-step registration form.  On step 2 you will be asked for your credit card (Visa, MasterCard, American Express, Discover) information.  Once you complete step 2 and submit the form, you are immediately eligible to participate.
* Starred fields are required
First Name *
Preferred (Nickname)
Middle Name
Last Name *
Create Password
Sex *      Birth Date * (mm/dd/yyyy)
Phone
Home/Primary
Work/Secondary
Cell/Other *
Email *
Street *
Street 2
City *
State*
ZIP *
Emergency Contact (Parent, Spouse, etc)
Name *   Relation
Phone *
Name 2 *   Relation 2
Phone 2 *
(Bee stings, foods, medicine, etc.)
(None, List Allergies, Required Accommodations, etc.)
(Google, Yelp, Friend, Doctor, etc.)
(http://onewiththewater.org/swim-lesson-faqs/#sa)

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