Authorize Payment Form
Membership Options:
*
prev
next
( X )
Single Swim Lesson-Single Swimmer
$
60.00
Quantity
0
1
2
3
Item subtotal:
$
0.00
5 Swim Lessons Package-55$/Lesson-Single Swimmer
$
275.00
Quantity
0
1
2
3
Item subtotal:
$
0.00
10 Lessons Package-50$/Lesson-Single Swimmer
$
500.00
Quantity
0
1
2
3
Item subtotal:
$
0.00
Single Infant Swim Lesson
$
30.00
Quantity
0
1
2
3
Item subtotal:
$
0.00
4 Infant Swim Lessons-25$/per lesson
$
100.00
Quantity
0
1
2
3
8 Infant Swim Lessons-22.5$/per lesson
$
180.00
Quantity
0
1
2
3
12 Infant Swim Lessons-20$/per lesson
$
240.00
Quantity
0
1
2
3
Enter coupon
Apply
Total
$
0.00
Credit Card
Name of Signer
*
First Name
Last Name
Participant's Name
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date Picker Icon
Comments
Your information is always secured and never shared with anyone.
WaterWay USA 2017.
Submit
Should be Empty: