Dream Big Swim Academy Online Registration

Registration

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Thank you for choosing Dream Big Swim Academy! Please make sure to check class availability before registering. Registration fees are non-refundable. No exceptions. Registration & enrollment are separate processes. Your registration must be accepted and your account activated before you can enroll. *Registration is not a guarantee of enrollment. Classes are enrolled on a first-come basis and may fill after checking availability.*

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Diagnoses/ Disabilities *

Special Needs *

Allergies*

Medications *

Primary Doctor/Pediatrician*

Diaper Size

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Diagnoses/ Disabilities *

Special Needs *

Allergies*

Medications *

Primary Doctor/Pediatrician*

Diaper Size

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Diagnoses/ Disabilities *

Special Needs *

Allergies*

Medications *

Primary Doctor/Pediatrician*

Diaper Size

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Diagnoses/ Disabilities *

Special Needs *

Allergies*

Medications *

Primary Doctor/Pediatrician*

Diaper Size

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Diagnoses/ Disabilities *

Special Needs *

Allergies*

Medications *

Primary Doctor/Pediatrician*

Diaper Size

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)