Swim and Stay Fit Registration

Register up to three swimmers for Swim and Stay Fit below. You can pay now via PayPal or submit your registration and mail a check.

For offline payments: Please note that your registration will not be confirmed until we have received payment.

Parent First Name*

Parent Last Name*

Email*

Phone*

Swimmer First Name*

Swimmer Last Name*

Swimmer Birthdate*

Day and time*

Session*

Register a second swimmer?*

No

Yes

Swimmer First Name

Swimmer Last Name

Day and time*

Swimmer Birthdate

Session*

Swimmer First Name

Swimmer Last Name

Day and time*

Swimmer Birthdate

Session*

Total Amount

$

Payment method *

Paypal
Offline Payment

Billing Zipcode*

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*

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Please support our efforts to provide low-cost and free swimming lessons and equipment to children in our community!