Swim Event Registration

Participant Information

Name Of Participant*

First Last

Email*

Have you made a registration and payment for this event already?*

Yes
No

You don't have to fill in the rest of your personal information if you have already filled out a registration for this event previously, and you will just pay the remaining amount.

Gender*

Female
Male

Your age at the time of training event...*

Phone*

Please include the country code.

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

.

Your Training Event

Choose the event type...*

Private or Small Group Training
OW Swim Clinic (1 day)
OW Swim Camp (multi-day)

Select your training scenario...*

Single Lesson 60 minutes
Single Lesson 90 minutes
Lesson Series (over a few days)
Weekly Lesson Series (over a few weeks)

Select your training topic or event...*

Custom Private Training
Pool Comfort Series
New Swimmer Series
Freestyle Fundamentals
Freestyle Advanced
Different Strokes
Swim Club (4-week pass)
Swim Club (single visit)

At which location?*

Courthouse Fitness in Salem Oregon
Mittleman Jewish Community Center in SW Portland
Turner Lake in Turner, Oregon

You may pay the 4-week pass fee or a single visit fee now. Or you may complete this registration, enter $0 into the payment amount, then pay in cash at your first attendance. Just choose "I have made other payment arrangements..." at the end of this form.

Which Swim Club session do you plan to attend?

Which instructor will you work with?*

Coach Jamee Small
Coach Mat Hudson
No Preference

Are you a current member of Courthouse Fitness?*

Yes
No
No, but I may be interested in membership

Are you a current member of MJCC?*

Yes
No
No, but I may be interested in membership

What is the starting date for your training event?*

Write either the scheduled starting date for the group training event, or the date you have agreed upon with your instructor for private lessons.

Select your OW Swim Clinics...*

Hagg Lake, June 27
Cottage Grove Lake, July 11
Hagg Lake, Aug 1
Turner Lake, Aug 15
Crescent Lake, Aug 23

To register for the Willamette River Swim Clinics on July 10 and 17, please visit this registration form instead.

Select your OW Swim Camp...*

Kaş Turkey, starting 26 September 2021

Enter your training payment amount...*

The non-refundable deposit is $60 per person. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Refer back to the Private Training page for lesson prices.

Enter your OW Swim Clinics payment amount...*

The non-refundable deposit for each swimmer is $20 for each clinic. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Refer back to the swim clinic page for prices.

Enter your OW Swim Camp payment amount...*

The non-refundable deposit for each swimmer is $150. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Refer back to the swim camp page for prices.

Total Payment

$0.00

.

Lodging At Camp

Room Request*

I will make my own lodging arrangements.
I would like to request a room.

Room Type*

1 person, single bed
2 people, two single beds
2 people, 1 double bed

Please understand that we do not arrange roommates for our guests. If you would like to share a room you will need to invite another swimmer or companion to join you.

My room companion will be...*

Who will you be sharing a room with?

Lodging arrival and departure dates are...*

It may be possible to stay extra nights are our chosen lodging. Enter the dates you intend to arrive and depart on.

Any additional note about your lodging request?

.

Payment

Total payment you intend to make...

$0.00

If this is not correct, you may go back and edit the payment amount on the previous page.

Please read our Privacy Policy. By filling out this registration form, you agree to trust us with very limited use of your personal your data to provide coaching services to you. We do NOT share your information with anyone outside our administrators. You also agree to be added to a mailing list that enables us to send you information about this particular training event and Mediterra's services in general. You are welcome to unsubscribe from the list at any time by following the link at the bottom of each email.

Please read our Terms and Conditions and our statement of Responsibilities, Waiver and Release.

Do you agree to the terms of these three documents?*

Yes
No

By submitting this registration you will be agreeing to the terms in these three documents, for yourself or on the behalf of the one you are registering for this event.

It appears that you will not be able to complete the registration at this time. If you have concerns or questions regarding our terms for participation, we would be glad to have you contact us to discuss it.

Select form of payment...*

I will pay with my CREDIT CARD.
I have made other payment arrangements with the Mediterra Office.

Credit Card

Card Details

Cardholder Name

Registration

for Mediterra’s Swim Training Events