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Registration Form:
Register online
or mail
the completed form and payment
to:
Set & Swim Aquatics, Inc.
P.O. Box 513, Hopewell Junction, NY 12533
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Parent Name
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Street
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City, State, Zip
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Best Daytime Phone
# * |
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Evening Phone # |
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e-Mail Address
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* If
paying by credit card or proving check info, please make info is the
same as it appears on your statement.
** We need your email address to communicate upcoming sessions with you
and mail you an electronic receipt. |
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Name of Swimmer |
Sex |
DOB (M/D/Y) |
Age |
Session ID
[Carmel, Gold's] |
Class Name |
Day |
Time |
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Payment Info Please Check Type:
□ Visa
□ MasterCard
□ American
Express □
Discover
Card#________________________________________ Exp Date__________
Check: Account#_______________________ Routing#____________________
If you are Mailing/Dropping off a Check: Check#________________________
* Note: You will not be confirmed until we receive payment
Any other swim programs attended in the past? ______________________________________
How did you first learn about Set & Swim? (Please circle one and write in
the details)
[Ad]
[Rec. Dept.] [Mail] [Flyer] [CFRC] [Gold's] [Friend]
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[Return
to Registration Information Page] |
