PRE-REGISTER FOR SWIM CLASSES

Please complete the information requested below to begin your registration process. A Member Service Representative will contact you within 24 hours to discuss enrollment options and complete your registration.

All members currently enrolled in classes receive priority registration. Please contact your school directly for enrollment.
Parent/Guardian Information (items with asterisk * are required for pre-registration)

Full Name* Registration Status: New Family Returning Family *Previous ASA member, but not enrolled in current session

Home Phone
*1 phone req.		 Work Phone Cell Phone

Address

City State Zip Code

Email* Confirm Email

At which American Swim Academy location would you like to schedule lessons:*   Dublin    Fremont    Livermore    Newark

Swim Student 1

Full Name

Birth Date (MM/DD/YYYY)

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

Full Name

Birth Date (MM/DD/YYYY)

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

Full Name

Birth Date (MM/DD/YYYY)

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?






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