Private Swim Lesson Request Form

* Required


Child Information
First Name:*
Last Name:*
Age:*
Skill Level/Swimming Experience:
Preferred Instructor:
Preferred Day(s):* Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Doesn't Matter
Preferred Time(s):*
Type of Request?* New
Renewal
Type of Lesson? * Single private 30 minute lesson: $30 M / $60 NM
Single private 30 minute lesson-5 pack: $120 M / $240 NM
Single Semi-Private 45 minute lesson: $25 M / $50 NM (per person fee)
Single Semi-Private 45 minute lesson-5 pack: $100 M / $200 NM (per person fee)

Parent/Guardian Information
First Name:*
Last Name:*
Phone Number:
Email:
Preferred Method of Contact: Phone
Email
Doesn't Matter
Other:
Additional Notes or Comments: