Private Swim Lesson Application

These lessons are available at a first come first serve basis. Special arrangements and instructor availability will determine exact times and dates. Please note: All swim lessons are NON-REFUNDABLE.

Personal Information

Parent or Guardian Name

(If Applicable)

Participant Full Name

Preferred/Nickname

Participant Age

Address

Cell Phone Number

Email

Emergency Contact Information

Emergency Contact 1

Name

Address

Phone Number

Email

Emergency Contact 2

(If Applicable)

Name

Address

Phone Number

Email

Swim Experience

Participant Swim Experience