Private Swim Lesson Registration Form

Private Swim Lesson Registration
Thank you for your interest in private/semi-private lessons. Once we receive this form, we will match you up with an instructor that fits your needs and preferred times.This process can take up to 2 weeks.
Select lesson type (Choose 1 of the 4 below)
1 - Private Lesson (member)
2 - Private Lesson (non-member)
3 - Semi-Private Lesson 2-3 students (member) See note below.
4 - Semi-Private Lesson 2-3 students (non-member) See note below.
*Participants are responsible for enrolling all individuals of a semi-private lesson. We are not able to match schedules or ability levels on behalf of participants.
The Swim Department is not able to match schedules, goals or ability levels on behalf of participants.
Desired type of Private Lesson*
List days/times you are looking for. Please note we currently DO NOT offer lessons the following times: Monday-Thursday 8:30a-11a and 4p-7p and Saturdays 9:30a-12p*
E-mail*
Phone Number*
Area CodePhone Number
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Contact Name*
First NameLast Name
Participant's Name*
First NameLast Name
Participant's Birth Date*
MonthDayYear
Participant's Sex*
If enrolling other individuals for semi-private lessons, list their info below:
2nd Participant's Name
First NameLast Name
Birth Date
MonthDayYear
Sex
Participant's Name
First NameLast Name
Birth Date
MonthDayYear
Sex
Office Use Only:
Staff Signature*
Enter the message as it's shown*
Should be Empty:

Private Swim Lesson Registration