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Youth Registration
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Select session
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--- Select Choice ---
MONDAY 4:00 PM - 4:45 PM: LEVEL 1-2
MONDAY 5:00 PM - 5:45 PM: LEVEL 2-3
MONDAY 6:00 PM - 6:45 PM: LEVEL 3-4
TUESDAY 4:00 PM - 4:45 PM: LEVEL 3-4
TUESDAY 5:00 PM - 5:45 PM: LEVEL 1-2
TUESDAY 6:00 PM - 6:45 PM: LEVEL 2-3
WEDNESDAY 4:00 PM - 4:45 PM: LEVEL 2-3
WEDNESDAY 5:00 PM - 5:45 PM: LEVEL 3-4
WEDNESDAY :00 PM - 6:45 PM: LEVEL 1-2
THURSDAY 4:00 PM - 4:45 PM: LEVEL 1-2
THURSDAY 5:00 PM - 5:45 PM: LEVEL 2-3
THURSDAY 6:00 PM - 6:45 PM: LEVEL 3-4
FRIDAY 4:00 PM - 4:45 PM: LEVEL 3-4
FRIDAY 5:00 PM - 5:45 PM: LEVEL 1-2
FRIDAY 6:00 PM - 6:45 PM: LEVEL 2-3
Parent/Guardian Name
*
First
Last
Phone
*
Email
*
Emergency Phone Numbers (if different from Prent)
Swimmer's Name
*
First
Last
Date of Birth
*
mm/dd/yyyy
Gender
*
--- Select Choice ---
Male
Female
Other
Current Skill Level:
Afraid of water/Will not put face in
Comfortable in water but cannot float alone
Can float on back/front but cannot swim
Can swim 5+ meters independently
N/A
Other
Medical Conditions/Allergies
Asthma
Ear sensitivity
Skin Sensitivity (chlorine)
N/A
Other
Learning/Physical Needs:
Very important for our instructors to know if a child has ADHD, sensory processing needs, or physical disabilities that require extra attention
Summer Camp Registration
Price:
$360.00
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Summer Camp Registration
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$360.00
Subtotal
Total
$360.00
$0.00
Media Use Consent & Release
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Yes, I opt in. I authorize the use of my student's image and likeness as described
No, I opt out. I request that my student's image or likeness not be used
Please read the following information regarding the use of photography, audio, and video recording during our swim sessions. By opting in, you allow Elite Swim Academy to use photographs, video footage, or audio recordings featuring your student for promotional materials, social media, our website, and future marketing campaigns. We promise to always use these materials respectfully and professionally.
Learning/Physical different Conditions/Allergies
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