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

Online Registration

Step 1 of 3
Biographical Waiver Payment Confirmation
Instructions: To become a One with the Water® member, please complete this registration form. Services provided for all locations and pricing, will be listed on the Shopping Cart page. Please input the swimmer's information. Swim session dates and 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.

Your card will not be charged after you submit your information; it will be charged after we have scheduled your lessons.

SWIMMER INFORMATION:
* Starred fields are required
First Name *
Preferred (Nickname)
Middle Name
Last Name *
Create Password
Sex *  
Birth Date * (mm/dd/yyyy)
Phone
Home *
Work
Cell *
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 *
(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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