Parent Name:

Parent email:

Parent Phone:

Parent Address:

Child Name:

Child Age:

Current Swim Level:

Ideal Time for Lessons:

Ideal Day(s) of the Week:

Private or Semi-private lessons? (no more than 3 students per coach in group):
PrivateSemi-private

Any Special Needs or Concerns:

Your Name:

Your email:

Your Phone:

Your Address:

Any Prior Instruction:

One or Two lessons per Week (Will be M/W or T/Th):
12

Ideal Time for Lessons:

Ideal Day(s) of the Week:

Any Special Needs or Concerns: