(866) 530-4117

So Far Our Students Have Saved
108 Lives

Pre / Supplemental / Additional
Payment Form

Happy Swimmers clients may also use this JTA CPR form for supplemental payments requested by our office.
Client Name/ Company name:  (Who's Paying this)
Student name:  (If paying for a specific student)
E-mail Address: 
Re-type Email: 
Training Date: 
What kind of payment is this for?:  CPR/First Aid/AED safety course
Lifeguard Certification Course class fee
Swim Lesson payment
Private Lifeguard Services
Card Replacement Fee
Amount Paying Now: $
Notes for the Office: 
(include host name if different than entered above)
Does this bring your balance down to zero?