Registration Form


Swimmers Discount:  The first two children in a family are at full cost but any child in the same session and class from the same family after that will receive a $10 discount per each additional child.  Deposit amount is per child and is the same for each child regardless of how many are enrolled from one family.

Referral Discount:  Any family that has previously been with Kintigh’s Pool that refers in a new family (that actually places a deposit) will get a $10.00 discount for their family per each new family they refer.

REGISTRATION FORM -     $70.00 Per Student

(A non-refundable $20.00 deposit, from the $70 total fee, is required PER CHILD at the time of registration to hold their spot.)

Student’s Name                                                Age

1)_______________________________        ________

2)_______________________________        ________

3)_______________________________        ________

4)_______________________________        ________


Parent/Guardian Name and Address:



Home Phone:                                           Cell Phone:

___________________________           __________________________

I was referred by:____________________________________________


Session Choice:

1st Choice Session #        X      X           3          4

Class Time:__________________

2nd Choice Session #         X      X         3           4

Class Time:___________________


Please Note:  Assume that you have received your first choice session and class time unless you hear from us saying differently.  You will receive a session reminder call about three days prior to the beginning of your session.  Please make sure the phone numbers you give us are current.  Thank you!

About your Child(ren)

Has your child(ren) ever taken swimming lessons before?

Yes              No

If yes, were they with us?

Yes             No

If yes, to first question, how many years?

Child 1     __________

Child 2     __________

Child 3     __________

Child 4     __________

If lessons were not with us, please, then where? ___________________________________

Is your child(ren) allergic to bee stings?

Yes               No

If yes, please mark which child(ren) above.
Do they need a medi-pen?      Yes          No


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