Safety First Swim School Pre-Registration

15155 W. Colonial Dr.

Winter Garden, FL 34787

www.safetyfirstswim.com

321-236-0240 ext. 5

Student's Name: *

D.O.B. * +

Additional Student's Name:

D.O.B. +

Additional Student's Name:

D.O.B. +

Primary Contact First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Cell Phone Number *

Email Address *

Swim Class * 🛈

What is your child's previous aquatic history? Please indicate whether or not your child gets his or her face wet and if your child uses floaties. *

0/255 characters

Emergency Contact *

Cell Number *

Preferred Start Date: * +

Preferred Class Time:

Flexible 🛈

Reminders:

Safety First Swim School will be contacting you within 48 hours.

Please visit www.safetyfirstswimschool.com for more information or call 321-236-0240 ext. 5.

For Office Use Only:

Official Start Date:_____________________ Official Start Time: _____________________