MITO Swimming Classes - Season 2023
Registration Form
Parent/Guardian Info
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
If Parent/Guardian cannot be reached.
Relationship to Student
Emergency Phone
Student Info
Student Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Mes
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1
2
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31
Día
Please select a year
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1928
1927
1926
1925
1924
1923
1922
1921
1920
Año
Age
Sex:
*
Female
Male
Prefer not to answer
Specify Special Medical Information Student 1
Select number of classes and location - Student 1
*
4 Classes Pack at Pembroke Falls Club House- $164.00
6 Classes Pack at Pembroke Falls Club House - $234.00
8 Classes Pack at Pembroke Falls Club House- $296.00
4 Classes Pack at Home - $193.00
6 Classes Pack at Home - $276.00
8 Classes Pack at Home - $349.00
Sub-Total S1: $
Add Student 2?
Add Student 2
Student 2 Info
Student Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Mes
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Día
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Año
Age
Sex:
*
Female
Male
Prefer not to answer
Specify Special Medical Information Student 2
Select number of classes and location - Student 2
*
4 Classes Pack at Pembroke Falls Club House- $164.00
6 Classes Pack at Pembroke Falls Club House - $234.00
8 Classes Pack at Pembroke Falls Club House- $296.00
4 Classes Pack at Home - $193.00
6 Classes Pack at Home - $276.00
8 Classes Pack at Home - $349.00
Sub-Total S2: $
Add Student 3?
Add Student 3
Student 3 Info
Student Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Mes
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Día
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Año
Age
Sex:
*
Female
Male
Prefer not to answer
Specify Special Medical Information Student 3
Select number of classes and location - Student 3
*
4 Classes Pack at Pembroke Falls Club House- $164.00
6 Classes Pack at Pembroke Falls Club House - $234.00
8 Classes Pack at Pembroke Falls Club House- $296.00
4 Classes Pack at Home - $193.00
6 Classes Pack at Home - $276.00
8 Classes Pack at Home - $349.00
Sub-Total S3: $
Totals
Total Student 1: $
Total Student 2: $
Total Student 3: $
Total Tuition: $
Notes:
Terms and Conditions
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Type a question
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MITO Payment
Accept payments by:
*
Check (Payment most be made out to MITO Sport & Fitness, LLC - 14248 NW 19Th Street Pembroke Pines, FL 33028)
Zelle (mito@madebymito.com)
Credit Card by Square (+2.90% - VISA, MasterCard & AMEX) Call or text me @954-548-0182
Sub-Total to Paid: $
Fee 2.90% (Credit Card): $
Total to Paid $
Total to be charged in your Credit Card by Square
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Registration Swimming Class Season 2023
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