SWIM TIME REGISTRATION FORM
Phone Email In Person Date:__________________________________________ Time:______________________________
Current clients complete* items only, new clients please complete entire form
Family Name*____________________________________________________________________ Home number*______________________________________________________
Mother's Name*__________________________________________________________________ Father's Name*_______________________________________________________
Cell: ( )__________________________________________________________________________ Alternate number: ( )_______________________________________________
Address: _______________________________________________________________________________________________________________________________________________________
City:_______________________________________________________________________________ Postal Code_____________________________________________________________
Email Address*________________________________________________________________________________________________________________________________________________
Circle the Following*
Season: Fall Winter Spring Summer
Location: Woodbridge Thornhill Pickering
Participants* Date of birth Level
1.
2.
3.
Day Request* Time Length
1.
2.
3.
Office Use Only Full Year?
Deposit Amount $_________________________________
Registration number_______________________________
Account number___________________________________
Payments: Visa Mastercard Cheque number_______________________ Cash Debit
Card number_____________________________________________________ Expiry________________________________________
Entered Stamp Here
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