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Registration:
Fill out this form and you will receive a message from (888)533-2084. When you recieve that message please reply with START. By filling out this form you agree to taking lessons and will be required to make the first payment before lessons begin. The pay 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
Yard Sign
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) and add their age(s). If anyone referred you please type their name. Are we doing lessons in your pool, community pool, or our pool?
*
By Submitting this form you're giving Madison Swim Academy permission to subscribe you to our newsletter/blog as well as contact you via email or phone. Do you consent?
*
Yes, I want Lessons
No, I do not want Lessons
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