Online Registration

Family Information

Family Name:
Home Phone:
Email Address:
Street Address:
City:
Postal Code:
Parent/Guardian #1 Name:
     Work Phone:
     Cell Phone:
Parent/Guardian #2 Name:
     Work Phone:
     Cell Phone:
Secondary Contact In Case of Emergency:
     Phone Number:
How did you hear about us?
(Word of Mouth, A Friend, Other...)

Student #1 Information

Name:
Gender:
Birth Date:
First Time Aqua Essence Student: Yes No
     Last Session Attended:
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:

Student #2 Information

Name:
Gender:
Birth Date:
First Time Aqua Essence Student: Yes No
     Last Session Attended:
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:

Aqua Essence Policies

* We do not 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.

* 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 2009-2010 swimming year. This initial fee must be paid by July 17, 2009.

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

Yes, I have read and agreed to the terms and policies outlined above.