Registration – Aquatics Locomotion

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

I am signing up for the following sessions

All three: Session 1: Aug. 18 – Sept. 17 Session 2: Sept. 22 – Oct. 15 Session 3: Oct. 20 – Nov. 12
Session 1: Aug. 18 – Sept. 17
Session 2: Sept. 22 – Oct. 15
Session 3: Oct. 20 – Nov. 12

I have read the liability waiver on the program description link and agree to this contract. *

Agree

I understand that to qualify for reimbursment, I must attend at least 5–6 classes during the month. *

Birthday month and day only