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Waitlist Sign-up:
Fill out this form and we'll notify you when lessons begin. By filling out this form you agree to taking lessons and will be required to make the first payment before lessons begin. MUST HAVE A POOL TO JOIN UNLESS DOING GROUP LESSONS FOR OLDER CHILDREN. The pay for next year will be paid monthly and before lessons begin.
Full Name
*
First Name
Last Name
Full Name of Child 1
First Name
Last Name
Full Name of Child 2
First Name
Last Name
Full Name of Child 3
First Name
Last Name
Full Name of Child 4
First Name
Last Name
Full Name of Child 5
First Name
Last Name
Child 1 Birthday
*
-
Month
-
Day
Year
Date Picker Icon
Child 2 Birthday
-
Month
-
Day
Year
Date Picker Icon
Child 3 Birthday
-
Month
-
Day
Year
Date Picker Icon
Child 4 Birthday
-
Month
-
Day
Year
Date Picker Icon
Child 5 Birthday
-
Month
-
Day
Year
Date Picker Icon
Phone Number
*
E-mail
*
example@example.com
How did you hear about us?
Please Select one
Google or another internet search
Social Media
Online Ad
Website
Word of Mouth
Other (Please specify...)
Other
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pool Address (Leave Blank if Address is Same as Home Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please tell us a little bit about your swimmer(s)
*
By Submitting this form you're giving Madison County Mobile Swim School LLC to subscribe you to our newsletter/blog as well as contact you via email or phone when enrollment opens again. Do you consent?
*
Yes, I want Lessons
No, I do not want Lessons
Signature
*
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