2025 Swim Lesson Registration – Carlisle Swim Club

Add Parent(s) Information

Parent Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Carlisle Swim Club Status*

For membership verification purposes, please include the first and last name of an adult associated with your Carlisle Swim Club membership.

Carlisle Swim Club Member Name*

First Last

Child Information

Which type of lessons are you registering for?*

Child's Name*

First Last

Age*

Date of Birth (mm/dd/yyyy)*

Child #2 Name (Private Lessons Only)

First Last

Age

Date of Birth (mm/dd/yyyy)

Lesson Selection

Private lessons will be offered on Tuesdays and Thursdays from 11:00 am - 5:00 pm. Please select your scheduling preference from the options below. While we attempt to accommodate your preferences, your preferred day and/or time may not be available.

Tuesday

11:00 am - 1:00 pm

1:00 pm - 3:00 pm

3:00 pm - 5:00 pm

Thursday

11:00 am - 1:00 pm

1:00 pm - 3:00 pm

3:00 pm - 5:00 pm

Select Session*

Select Level*

Session #1, Levels 1, 2 or 3: Select Time*

Session #1, Levels 4 or 5: Select Time*

Session #2, Levels 1, 2, or 3: Select Time*

Session #2, Levels 4 or 5: Select Time*

Session #3, Levels 1, 2 or 3: Select Time*

Session #3, Levels 4 or 5: Select Time*

Payment Info

Private Lessons (select one):

Member Price - Group Lessons:

Price:

Non-Member Price - Group Lessons:

Price:

Payment Method*

Credit Card Processing Fees

Price: $0.00

A credit card processing fee of 2.90% plus $0.30 per transaction will be applied to all transactions paid by credit card. This is the cost to the Carlisle Swim Club to process your credit card transaction. To avoid this fee, you have the option to pay by check.

Checks should be mailed to: Carlisle Swim Club PO BOX 500 Carlisle, PA 17013

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total

Order Token