EA Group Swim Lessons

EA Group Swim Lessons Registration

At the Elks Lodge Pool
Please complete this form for each swimmer individually.
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Phone*
Please enter a valid phone number.
Swimmers Name*

First NameLast Name
Swimmers Age*
Which Level is Appropriate for your Swimmer?*

Level 1: SeahorseLevel 2: DolphinLevel 3: SharkLevel 4: River OtterLevel 5: SwordfishLevel 6: Manta Rays
Swimmer - Choose Your Session(s):*

WEEK 6 - Oct. 13-16, 2025WEEK 7 - Oct. 20-23, 2025
Is a member of your immediate household a member of one of the following organizations?*

Do you currently have an EA Swimmer on the team? (15% off)No
Calculation

Lessons Purchased

USD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

EA Group Swim Lessons Registration