Registration Form 2010

Child/Children Information:

*Name: *Birthdate:
                (First & Last Name)                                          (Month/Day/Year)

*Name: *Birthdate:
                (First & Last Name)                                          (Month/Day/Year)

Home Pool:     Access to Pool:
*Previous Swimming Lessons: Yes No   
*Potty Trained: Yes No

*Medical Information:

(Please Provide a Doctor’s Note if needed to the Office
before your first lesson.)

*Location Requested:
Palm Beach Gardens / Jupiter Location
        (Offers Monday thru Thursday, Friday & Saturday)  
Wellington (Monday thru Thursday)  
Acreage / Loxahatchee (Offers Tuesday & Thursday)

*Please Choose the Lessons Desired:
Two 15 Minute Private Lessons  
Four 15 Minute Private Lessons  
Two 30 Minute Private Lessons
One day a week on Friday (PBG Location Only)
One day a week on Saturday (PBG or Acreage / Loxahatchee Location Only)

*Please Indicate Time of Day that is best for your Child:

* By checking this box I agree to the following Policy, Terms and
         Conditions.
         Please see our Water Safety Tips for more information.

Here at Kids first we would like to welcome you to another great year. We look forward to working with you and your children. Please remember that time slots are limited by Location and will be filled on a first come basis.

We accept the following Forms of Payment:

Visa, Master Card, Discover, Cash
Checks (Please Make Checks Payable to Kids 1st Swim School, LLC)

First payment:

Registration:
$25.00 (One Child) or
$40.00 (Family Registration)
(The Office will call to set up the Lessons once the Registration Form has been filled out and submitted.)

*Security Code:

* Required