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                                                         Photo copyright of Dr. Harvey Barnett2009            

Registration Form                                     SwimSafeNaples.com

SUBMITTING THIS FORM  SERVES TO RESERVE A TIME SLOT, I WILL BE SENDING YOU AN EMAIL WITH A LINK SO YOU CAN REGISTER YOUR CHILD WITH ISR .
Contact Information

First Time and Refresher Students

(Please follow the directions carefully to ensure quick registration)

  1. Please be sure to read the entire page" About ISR Lessons"  first so you are familiar with how ISR lessons are done, as well as the Pool Rules document which can also answer any questions you might have more specifically.  If you have a planned vacation during the scheduled weeks of lessons please discuss this with me before enrolling.
  2. Fill out the Enrollment Form below and click "SUBMIT".
  3. You will receive confirmation via email from me and a link to the National Registration Website (or Update link if you are a returning student).

*****Lessons are 5 days a week, Monday through Friday, 10-minute one-on-one lessons per day for 4-8 weeks depending on the age and ability of the child.******
Child # 1 Name:
Child #1 Birthday:
Level:
Child #2 Name:
Child #2 Birthday::
Level:
Mother's Name:
Mother's Cell Phone:
Father's Name::
Father's Cell Phone:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Time of the day preferred for lessons:
What month would like to start lessons?:
Where did you learn about ISR Lessons?:
Email:
Comments:

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