Deluxe Package – WET DOLPHIN SWIMMING ACADEMY

Student Type *New StudentRegular Student

First Name *

Last Name *

Email Address *

Confirm Email Address *

Phone *

Gender *BoyGirl

Age *

Lesson Day 1 *

Lesson Day 2 *

Please choose two different lesson days (we’ll confirm availability).

Preferred Time *

Start Date (Monday) *

Start Date (Tuesday) *

Start Date (Wednesday) *

Start Date (Thrusday) *

Start Date (Friday) *

Start Date (Saturday) *

Location *City of DoralOther (outside Doral)

Mensualidad

New Student Registration *Registration (Mandatory): $50

New Student Uniform *Uniform (Mandatory): $25

Regular Student ExtrasExtra Uniform: $75

Discount Coupon0 / 5

Discount: *$25

Total US$

Your Information

Name: {name-1-first-name} {name-1-last-name}

Email: {email-1}

Phone: {phone-1}

Gender: {radio-2}

Age: {number-1}

Student Type: {radio-1}

Lesson Days: {select-2} - {select-3}{select-4}{select-5}{select-6}{select-7}{select-8}

Start Date: {date-1}{date-2}{date-3}{date-4}{date-5}{date-6}

Preferred Time (tentative): {select-1}

Order Summary

Package

{hidden-5}

Location

Location: {radio-3}

10 Lessons (2/weekly × 5 weeks)

$400.00

10 Lessons (2/weekly × 5 weeks)

$575.00

Registration

$50.00

Uniform

$25.00

Extra Uniform

$75.00

Discount (Coupon)

-$25.00

Order Total: ${calculation-1}

Credit / Debit Card *

Order Total