New Client Account Request
Please complete this form JUST ONCE. Do not fill out more than one time. If you have a duplicate account, you may have issues registering online.

Once we have created your account, we will get back to you by email with further instructions.

* To gain online access for Summer 2024 registration, this form must be completed by Monday June 3. *

Questions? Contact us at aquaventures@telus.net.
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Email *
Primary Contact: first & last name, relationship to child *
Primary Contact CELL (XXX-XXX-XXXX) *
Primary Contact HOME (XXX-XXX-XXXX)
Additional Contact: first & last name, relationship to child
Additional Contact EMAIL
Additional Contact CELL (XXX-XXX-XXXX)
Any other family contacts? Include first & last name, relationship to child, cell number and/or email.
Home address, including postal code *
Child 1: first & last name, gender, date of birth (MM-DD-YYYY), any medical conditions we should know about *
Child 2: first & last name, gender, date of birth (MM-DD-YYYY), any medical conditions we should know about
Child 3: first & last name, gender, date of birth (MM-DD-YYYY), any medical conditions we should know about
Child 4: first & last name, gender, date of birth (MM-DD-YYYY), any medical conditions we should know about
How did you hear about us?
If you were referred to our program by someone who has swam with us before, note parent(s) and/or child(ren)'s names here. They will receive a $50 referral credit after you complete your first set of lessons with us.
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