Contact Information Update

Form filled out Date and time
Let's get updated!
Who is currently enrolled in your account?*
What can we update for you today? (choose all that apply)*
- Phone Number
- Email Address
- Street Address
- Credit Card Expiration Date
- Student Medical History
- Student Last Name
- Account Holder Last Name
- Emergency Contact
In order to locate and verify your account, we'll first need the contact information that is currently on your file.
Current Information
Account Holder First Name*
Account Holder Last Name*
Phone Number*
Email Address*
Student Medical History
Student Medical History
Street Address*
City*
State*
ZIP Code*
Student
First Name*
Last Name*
Updated Last Name
Student Medical History
Student Medical History
Do you have another currently enrolled student?
- Yes
Student
First Name*
Last Name*
Updated Last Name
Student Medical History
Do you have another currently enrolled student?
- Yes
Student
First Name*
Last Name*
Updated Last Name
Student Medical History
Do you have another currently enrolled student?
- Yes
Student
First Name*
Last Name*
Updated Last Name
Student Medical History
Do you have another currently enrolled student?
- Yes
Student
First Name*
Last Name*
Updated Last Name
Student Medical History
Updated Information
Updated Street Address*
Updated City*
Updated State*
Updated ZIP Code*
Emergency Contact Full Name*
Emergency Contact Relation*
Emergency Contact Phone Number*
Updated Phone Number*
Updated Email Address*
Updated Account Holder Last Name*
Updated Credit Card Expiration Date
MM*
YYYY*
Section Break
How would you rate your experience at the Gold Medal Swim School?
Comments - Overall Experience
How would you rate your instructor(s) at the Gold Medal Swim School?
Comments - Instructor(s)
How would you rate your the overall cleanliness of the facility?
Comments - Facility Cleanliness
How would you rate the customer service staff at the Gold Medal Swim School?
Comments - Customer Service Staff
Would you like a customer service member or manager follow up with you regarding your feedback?
We appreciate your feedback. A manager will contact you shortly to discuss how we can improve your Gold Medal Swim School experience. Thank you for your time and consideration.