Swim Survival Application

Share parent and child details below. We will follow up with class availability and next steps.

Parent Details

Parent first name *

Parent last name *

Phone *

Email *

How did you hear about us?

Notes

Parent ID document (optional)

Upload a photo or PDF of a parent ID if available.

Child first name *

Child last name *

Date of birth *

Can walk independently?

Can swim?

Course requested *

Child medical conditions

Yes, this child has medical considerations

Share any medical notes or accommodations needed.

Child birth certificate (optional)

Upload a photo or PDF if you have it available.

You are submitting details for 1 child. We will contact you soon after reviewing the application.