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2018 Lesson Registration Form for Members

This registration form is for...

  • lessons only
  • members of Kemp Mill Swim Club (for non-members, please use non-member form)
  • online credit card payment
  • to register for the team, use the Team Registration form

For other forms of payment, contact the team Rep at kempmillswimteam@gmail.com.

LOG IN to SwimTopia and enter your child's information. You will be able to add multiple children to your registration.

There is an annual registration fee of $20/child for members. Please indicate on the form below whether you would like Private Swim Lessons or Semi-Private Swim Lessons. Private Lessons are $30/half hour for one-on-one lessons with an instructor. Semi-private lessons are $45/half hour for two or three children with one instructor. All payment for lessons is paid directly to the the instructor. 

Once we receive your registration, our Swim Lessons Coordinator, Gavriella Lebowitz, will contact you via email to schedule your lessons.

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
Required for login
Primary Phone

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+ Add another parent/guardian
Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Lesson Type

Would you like Private or Semi-private lessons for your child? *

For Semi-Private Lessons

If you would like semi-private lessons, please indicate who you will be sharing the lesson with?

Permission

I understand that participation in swim lessons is entirely voluntary. I understand that swim lessons may involve swimming and related pool activities. I know and understand the risks and dangers involved and I know and understand that unanticipated dangers might arise. I hereby release Kemp Mill Swim Club from any responsibility for injury, which might occur as a result of participation in private or semi-private swim lessons.

I give permission for my child to participate in all swim lesson related activity, except as noted. I also give permission to authorized personnel to carry out such emergency diagnostic and therapeutic procedures as may be necessary for me or my child, and also permit such treatment procedures to be carried out at, and by the local hospital(s) for me or my child in the event of an emergency. I understand that any medical expenses will be billed directly to me or my insurance company.

*
Enter your initials to indicate acceptance: *