Recurring Lesson Application

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!
🏊 New Registration
Parent Name*

First NameLast Name
Phone Number*
Please enter a mobile phone number.Format: (000) 000-0000.
Email*

Confirmation EmailPlease provide a valid email address to receive important communication and your confirmation!
How did you hear about us?*
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?*
Select a number from 1-4 to indicate the number of kids you are registering..
Do you currently have one or more kiddos enrolled?*
When would you like to have this new lesson?*
How many days per week are you interested in? (# of lessons per week per kiddo)*
If only one spot were to open, would you prefer to...*

Tell us about your kiddo(s)!
YesNo
Child Name*

First NameLast Name
Age*
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 NameLast Name
Child Two Age
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 NameLast Name
Child Three Age
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 NameLast Name
Child Four Age
Round up if your kiddo is within a couple months of a birthday.
Child Four Medical/Adaptive Needs

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!**
Direct Overlap: The exact same lesson timeStaggered: Start times close to each otherBack-to-BackAny of the Above
FemaleMaleNo Preference

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!
I have read this important information!

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)*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred times for MONDAYS*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for TUESDAYS*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for WEDNESDAYS*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for THURSDAYS*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for FRIDAYS*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for SATURDAYS*
**Use the CTRL or COMMAND buttons to select multiple times
Select your preferred time for SUNDAYS*
**Use the CTRL or COMMAND buttons to select multiple times

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.
We will be paying for our own lessonsRMHSHope Floats ScholarshipAccount 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 NameLast Name
Bank Name*
CheckingSavings
Routing Number*
Please enter your 9 (nine) digit routing number
Account Number*
Please enter your account number
Yes

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
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.*

Clear
Should be Empty:

Tell Us About You!