2025 Ashley Survival Swim Health & Registration Form

What location is my child swimming at & Child's Swim Time Reservation. Click 1 location & 1 time slot below per child:

Child’s 1st & Last Name (all caps)-B (boy) or G (girl)-Age (in mos). (Ex: EVANN-G-44m)

First NameLast Name

Primary Parent Name / Cell Phone

Primary Parent Email Address

example@example.com

Choose ONE Option:

Check ALL boxes that apply:

WHAT was the last thing your child did in the water & WHEN was this?

List in months, in order, when your child did the following things:Sat up, Crawled, Walked(Ex: 6m, 9m, & 14m or not yet)

Has your child ever taken swimming lessons: traditional or survival type? If so, when and what did your child learn/ still retain present day?

2026 Survival Swim Registration