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.

SWIMMER INFORMATION

* Starred fields are required

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

Sex * Female Male

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 *

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?

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

What is your preferred pool?

My child meets the requirements for lessons in Santa Monica.

I agree and have read the Special Accommodations explanation.

(http://onewiththewater.org/swim-lesson-faqs/#sa)

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?