Tell Us About You!
Thanks for your interest in enrolling your kiddo in private lessons at Little Kickers! We will place families onto our permanent schedule on a first come, first served basis. Please complete this form in full and create your WellnessLiving account to ensure a smooth enrollment process!
Category
🏊 New Registration
Parent Name
*
First Name
Last Name
Phone Number
*
Please enter a mobile phone number.
Email
*
Confirmation Email
Please provide a valid email address to receive important communication and your confirmation!
How did you hear about us?
*
Please Select
Google
Yelp
Facebook or Instagram
Referral
Kickin It Kids Gym
RMHS (Rocky Mountain Human Services)
Other
Tell us about the other source and/or referral!
*
Please list the name of the person or other source who referred you!
How many kids would you like to enroll?
*
Please Select
1
2
3
4
Select a number from 1-4 to indicate the number of kids you are registering..
Do you currently have one or more kiddos enrolled?
*
Please Select
No
Yes
When would you like to have this new lesson?
*
Please Select
Near the same time as my current lesson
Willing to move lesson times to be at the same time
I would prefer to bring them on different days
How many days per week are you interested in? (# of lessons per week per kiddo)
*
Please Select
1
2
If only one spot were to open, would you prefer to...
*
Please Select
Wait for two open slots
Schedule one lesson while waiting for a second spot
Back
Next
Save
Tell us about your kiddo(s)!
Does your child (or one of your children if you a registering multiple) have medical or adaptive needs?
*
Yes
No
Child Name
*
First Name
Last Name
Age
*
Please Select
Less than 1
1-3
4-5
6-7
7+
Round up if your kiddo is within a couple months of a birthday.
Medical/Adaptive Needs
Please use this space to let us know what kind of medical conditions or adaptive needs your kiddo(s) has so that we can prepare their instructor(s).
Second Child's Information
Child Two Name
First Name
Last Name
Child Two Age
Please Select
Less than 1
1-3
4-5
6-7
7+
Round up if your kiddo is within a couple months of a birthday.
Child Two Medical/Adaptive Needs
Third Child's Information
Child Three Name
First Name
Last Name
Child Three Age
Please Select
Less than 1
1-3
4-5
6-7
7+
Round up if your kiddo is within a couple months of a birthday.
Child Three Medical/Adaptive Needs
Fourth Child's Information
Child Four Name
First Name
Last Name
Child Four Age
Please Select
Less than 1
1-3
4-5
6-7
7+
Round up if your kiddo is within a couple months of a birthday.
Child Four Medical/Adaptive Needs
Back
Next
Save
Let us know what works best for you!
Timing for Multiple Kiddos
Please let us know how we can schedule your kiddos by selecting from the options below. The more flexibility you having in timing, the sooner we can process your request! **If your kids need to swim on different days, please complete separate registration forms!**
Timing for Multiples
*
Direct Overlap: The exact same lesson time
Staggered: Start times close to each other
Back-to-Back
Any of the Above
Do you have a requirement on the gender of your kiddo's swim instructor? (Please note: Any requirements here could potentially lengthen your time on the waitlist)
*
Female
Male
No Preference
Back
Next
Save
Please read thoroughly!
We would hate for you not to get a spot due to misunderstanding how we schedule and what our availability is! It will just take a quick few to read through the below!
Our schedule availability is dictated by kids graduating out of their lesson times!
Meaning, if your only availability is for an hour or two during our peak times, there’s a chance it may take longer for you to be offered a spot. The more time frames you can give us, the higher the likelihood of getting a spot!
Please be intentional with the days/times you are providing!
If you cannot accept the first time offered to you, our team will make an effort to offer you one more alternative time before asking you to resubmit your registration. It takes us a ton of work to coordinate lesson times, so please only mark down when you are actually available and let us know if that changes!
Acknowledgement
*
I have read this important information!
Back
Next
Save
Please select ALL the days & times that apply below!
**Use the CTRL or COMMAND buttons to select multiple times
What DAYS are you available? (please select all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred times for MONDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
2:00pm-2:30pm
2:30pm-3:00pm
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
6:00pm-6:30pm
6:30pm-7:00pm
7:00pm-7:30pm
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for TUESDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
2:00pm-2:30pm
2:30pm-3:00pm
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
6:00pm-6:30pm
6:30pm-7:00pm
7:00pm-7:30pm
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for WEDNESDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
2:00pm-2:30pm
2:30pm-3:00pm
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
6:00pm-6:30pm
6:30pm-7:00pm
7:00pm-7:30pm
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for THURSDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
2:00pm-2:30pm
2:30pm-3:00pm
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
6:00pm-6:30pm
6:30pm-7:00pm
7:00pm-7:30pm
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for FRIDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
2:00pm-2:30pm
2:30pm-3:00pm
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
6:00pm-6:30pm
6:30pm-7:00pm
7:00pm-7:30pm
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for SATURDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
2:00pm-2:30pm
2:30pm-3:00pm
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for SUNDAYS
*
8:00am-8:30am
8:30am-9:00am
9:00am-9:30am
9:30am-10:00am
10:00am-10:30am
10:30am-11:00am
11:00am-11:30am
11:30am-12:00pm
12:00pm-12:30pm
12:30pm-1:00pm
1:00pm-1:30pm
1:30pm-2:00pm
**Use the CTRL or COMMAND buttons to select multiple times
Back
Next
Save
Third Party Billing
Please indicate whether you will be making use of funding from one of our partners or if you are a returning family with account credit to be applied to your first bill(s). Please note that Developmental Pathways is no longer an available option.
Billing Choice
*
We will be paying for our own lessons
RMHS
Hope Floats Scholarship
Account Credit (previously enrolled families)
ACH
Please provide your account information to set up automatic ACH withdrawals for lesson payments. Even if you are paying with funding from one of our partners, we still need to have ACH payment information on file. We will not charge you if we receive payment in full from the partners.
Name on Account
*
First Name
Last Name
Bank Name
*
Account Type
*
Checking
Savings
Routing Number
*
Please enter your 9 (nine) digit routing number
Account Number
*
Please enter your account number
Please indicate below that once we confirm your lesson day and time slot we have your permission to charge your account for lessons. If no, please contact us at registration@littlekickersco.com before submitting your application.
*
Yes
Back
Next
Save
Create Your WellnessLiving Account
Head to WellnessLiving and create your account with us (if you haven't already) and sign the waivers.
Click here to create your account, add payment information, and sign our waivers:
https://www.wellnessliving.com/signup/littlekickersswimschool
Confirm you've created your account and signed the waivers.
*
Yes
Policy Agreement
Click here to read our policies:
https://www.littlekickersco.com/policies
and sign below to accept
I've have read and accept Little Kickers Swim School's policies.
*
Save
Submit
Should be Empty: