Online Registration

Family Information

Family Name:*
Home Phone:*
Email Address:*
(Evenings & Weekends)
Street Address:*
City:*
Postal Code:*
Parent/Guardian #1 Name:*
     Work Phone:*
     Other Phone:*
     (Evenings & Weekends)
Parent/Guardian #2 Name:
     Work Phone:
     Other Phone:
     (Evenings & Weekends)
Secondary Contact In Case of Emergency:*
     Phone Number:*
How did you hear about us? (eg. Word of Mouth, A Friend, Other...)
We would like to thank the person that referred you to us so be sure to tell us his/her name!

* Indicates a required field.

Student #1 Information

Name:*
Gender:*
Birth Date:*
First Time Aqua Essence Student: Yes No
     Last Session Attended:
     (Winter, Spring or Summer)
Pool Location:
Level:
Day(s):
Time (1st Choice):
Time (2nd Choice):
Fee: (see registration info)
If there are any special needs and/or medical issues we should be aware of, please briefly describe them:

* Indicates a required field.

Student #2 Information

Name:
Gender:
Birth Date:
First Time Aqua Essence Student: Yes No
     Last Session Attended:
     (Winter, Spring or Summer)
Pool Location:
Level:
Day(s):
Time (1st Choice):
Time (2nd Choice):
Fee: (see registration info)
If there are any special needs and/or medical issues we should be aware of, please briefly describe them:

Registration Password (optional)

Enter a password below and we can save all of the registration information you entered above. Next time you need to register, you can just login with your email address and password, and this registration form will already be filled out for you!

Password:

Aqua Essence Policies

We do not refund or reschedule classes for student absences.

Days and pools may change due to unforeseeable circumstances.*

We do our best to ensure minimal instructor absences from our classes. In a situation where a substitute may not be found we reserve the right for your safety to cancel this class. We will make all attempts to reschedule a missed class that occurred as a result of our absence or make alternate arrangements (including but not limited to a refund or credit).*

Before signing this registration form please check the box below indicating that you have read over the absent and no make-up class policies attached in the program information brochure.*

We require a $50.00 holding fee (non-refundable) that will confirm your decision to swim with Aqua Essence for the 2010-2011 swimming year.*

* We accept postdated cheques at time of registration. Please make cheques payable to Aqua Essence.