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 selected on the next page and 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 * Female Male Birth Date * (mm/dd/yyyy)

Phone	Home/Primary		Work/Secondary
	Cell/Other *		enter full number (555) 555-1212 x212

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? *

If yes to the above question, please list allergens:

Is the swimmer allergic to bee stings? *

Any history of seizures? *

Anything else we should know about the swimmer?

How did you hear about us?

Would you like to choose your coach/instructor, if available?

(We will assign the best coach to help you achieve your goals.)

I have read the Cancellation Policy. There are NO make-up swimming lessons. *

**CANCELLATION POLICY ** Please make every effort to attend all lessons. We know things come up and schedules change, however, our pool space, insurance and instructors are booked 2 weeks in advance. Make-Up swimming lessons are not guaranteed and refunds are not issued for missed lessons. Upon request, we can convert your lesson credit into a tax-deductible donation.**

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