EZ Swim Aquatics – Suffolk County Long Island PRE-REGISTER FOR SWIM CLASSES Please complete the information requested below to begin your registration process. One of our instructors will contact you within 24 hours to discuss your scheduling needs and complete your registration. Parent/Guardian Information (items with asterisk * are required for pre-registration) Registration Status: New Family Returning Family *Student from last summer First Name* Last Name* Main Phone* Work Phone Cell Phone Address City State Zip Code Email* Confirm Email What town would you like to schedule lessons:* How did you hear about us? Please Select OneCar SignWaldo TribuneBrochureSouthampton Chamber of CommerceBingYahooThumbtackMantaCompetitorDirect MailDan’s PaperEast Hampton IndependentEast Hampton PressEventGoogleGoogle OffersGot Daily DealsGrouponInternetFlyerLivingSocialLocalMarket2MeBusiness CardMerchant CirclePatchReferralSchool FlyerSouthampton PressSouthampton IndependentYellow PagesYelpOther Swim Student 1 First Name Birth Date (MM/DD/YYYY) Gender Male Female Program: Infant/Toddler Pre-Schooler Beginning Intermediate/Adv Young Adult Adult Preferred Class Time (1st Choice): Sun M Tu W Th F S Morning Afternoon Evening Preferred Class Time (2nd Choice): Sun M Tu W Th F S Morning Afternoon Evening Preferred Class Time (3rd Choice): Sun M Tu W Th F S Morning Afternoon Evening Is there any additional information about this student you would like to share with us? Swim Student 2 First Name Birth Date (MM/DD/YYYY) Gender Male Female Program: Infant/Toddler Pre-Schooler Beginning Intermediate/Adv Young Adult Adult Preferred Class Time (1st Choice): Sun M Tu W Th F S Morning Afternoon Evening Preferred Class Time (2nd Choice): Sun M Tu W Th F S Morning Afternoon Evening Preferred Class Time (3rd Choice): Sun M Tu W Th F S Morning Afternoon Evening Is there any additional information about this student you would like to share with us? Swim Student 3 First Name Birth Date (MM/DD/YYYY) Gender Male Female Program: Infant/Toddler Pre-Schooler Beginning Intermediate/Adv Young Adult Adult Preferred Class Time (1st Choice): Sun M Tu W Th F S Morning Afternoon Evening Preferred Class Time (2nd Choice): Sun M Tu W Th F S Morning Afternoon Evening Preferred Class Time (3rd Choice): Sun M Tu W Th F S Morning Afternoon Evening Is there any additional information about this student you would like to share with us? Pre-Register
