2021 Swim Lesson Enrollment Form

Please provide the requested information below to help us process your request to enroll in swim lessons.

Primary Contact Information

Please provide the following contact information:
Parent / Guardian Name Parent / Guardian Name * First Last
Primary Contact Phone Number Primary Contact Phone Number * - ### - ### ####

Please enter the primary phone you wish us to use when contacting you.
Primary Email *

Please provide an email address we can use to communicate information about your enrollment, schedule changes and billing inquiries.
Swimmer Information

Please provide the following information to assist us in enrolling your swimmer.
Swimmer Name Swimmer Name * First Last
Swimmer's Birth Date Swimmer's Birth Date * / MM / DD YYYY
2nd Swimmer 2nd Swimmer First Last
2nd Swimmer's Birth Date 2nd Swimmer's Birth Date / MM / DD YYYY
3rd Swimmer 3rd Swimmer First Last
3rd Swimmer's Birth Date 3rd Swimmer's Birth Date / MM / DD YYYY
Scheduling Information

Please select your preferences below
Does your swimmer have an instructor gender preference?

Does your swimmer have an instructor gender preference? Prefer a Female Instructor Prefer a Male Instructor No preference gender preference

Please note: Due to current staffing, selecting a gender preference may limit the availability of lesson spots.
Please select which days you would be interested in scheduling.

Please select which days you would be interested in scheduling. Monday Tuesday Wednesday Thursday Friday Saturday
Which day of the week is your top choice?

Please select your first choice of days.
Time of Day

Time of Day Morning (9am to Noon) Mid Afternoon (Noon to 2pm) Afternoon (2pm to 5pm) Evening (5pm to 7pm) Anytime

Please indicated which time of the day you would most prefer to schedule your lessons.
More Information

Please provide any other information that will help us to best provide our goal of safe, nurturing, and sound swim lessons for your swimmer.

2021 Swim Lesson Enrollment Form

2021 Swim Lesson Enrollment Form

Primary Contact Information

Swimmer Information

Scheduling Information