Request Enrollment Online This is a request form to help reserve your spot. You are not officially enrolled until we call you back to confirm the date and payment. Last Name Parent's Last Name Street Address City State Zip How did you hear about us? website internet search Facebook Tulsa Kids Phone Book Drive By Party Word of Mouth Tradeshow Instructor Business Card Coupon Living Social Have you been a customer with Miller before? Yes No If yes, which location Miller Aquatic Center MainMetro Memorial Indian Springs Philcrest Owasso If yes, what year? Phone Email Please list all children's names, date of birth, and age Emergency Contact Name Emergency Contact Phone 1st Preference Summer School Year Summer and School Year Requested Day, Session and Time
