Student Information Sheet

This form is designed for us to gather more information about your student and to obtain the necessary emergency contact details before we get started. Please feel free to reach out if you have any questions. Thank you!

Parent/Guardian Name

First Name

Last Name

Student Name(s)

If more than one student, please separate first names with a comma.

First Name

Last Name

Student Birthdate(s)

Parent/Guardian Email

Primary Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Address (Pool Location)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Medical Conditions

Please list any medical conditions or recent injuries that may impact swim class.

Favorite Things

Tell us about your child's interests (characters, colors, animals, books, movies, etc.)!

Media release consent

Please inform us of your preferences regarding the sharing of any photos or videos of your student(s) online.