2017 W I-35 Frontage Rd
Edmond, OK 73013

(405) 757-3300

Mon – Thurs: 5 a.m. – 9 p.m.
Friday: 5 a.m. – 8 p.m.
Saturday: 7 a.m. – 5 p.m.
Sunday: 9 a.m. – 5 p.m.

Aquatic Class Registration

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Member of Mercy Fitness Center?*
- Yes
- No
How did you learn about the Aquatics Program at Mercy Fitness Center?
- Internet
- Facebook
- Email
- Referral
If you were referred:

If you were referred, please provide the name of the person who referred you so you AND your friend can each receive a $10.00 credit against any purchase of 6 lessons or more.
Emergency Contact Name*
First Last
Contact Number*
Emergency Contact Email*

* The contact name & number above is the number we will utilize for all emergency closings, make ups and any other correspondence needed from the Aquatic’s Department.
I am requesting registration for:*
- Adult Learn-to-Swim
- Adult SwimFit
Special Needs*
If none, mark n/a
Medical Conditions/Allergies*
If none, mark n/a
Signature Line*

By entering your name here, you agree the information you provided Is accurate and complete. You hereby release, waive, and relinquish any and all actions for personal injury arising as a result of participating in such program-mentions swimming program.
Date*
MM slash DD slash YYYY
- By submitting this form, I consent to receive communications from Mercy Fitness Center.

2017 W. I-35 Frontage Road
Edmond, OK 73013
Phone: (405) 757-3300
mercyfitnessgm@gmail.com

Mon – Thurs: 5 a.m. – 9 p.m.

Friday: 5 a.m. – 8 p.m.

Saturday: 7 a.m. – 5 p.m.

Sunday: 9 a.m. – 5 p.m.

Mon – Thurs: 8 a.m. – 8 p.m.

Friday: 8 a.m. – 7 p.m.

Saturday: 9 a.m. – 3 p.m.

Sunday: 11 a.m. – 3 p.m.