Samantha's Swimming Waitlist
Please fill out this form to join our waitlist in the interim of trying to find a replacement for Appointments-Plus. You must complete at least 1 summer session before being considered for lessons during the school year.
What type of client are you?
Returning client
New client
Other
What session are you interested in?
Fall 2024 (Sept-Dec)
Winter 2025 (Jan-Mar)
Spring 2025 (Apr-mid Jun)
Summer 2025 (5, 2 week sessions)
What type of lesson are you inquiring?
Infant Swim (ages 1-2)
Toddler/preschool (2-5)
Young Child lessons (5-12)
Advanced lessons/technical help/supplemental swim team work (13-17)
Adult Lessons (18 & older)
Other
Parent/Guardian Information
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
Please provide a number to receive text.
Parent/Guardian Email
example@example.com
Please tell us who referred you:
Please Select
Facebook
Google
A friend
If referred by a friend, who can we thank?
Child(ren) Information
Swimmer Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
School & Grade Level
Swimmer Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
School & Grade Level
Swimmer Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
School & Grade Level
Please leave us notes of your availability, child's swim abilities, etc.
Days available (chose all available):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time(s) available (chose all available):
8:30-12:30
12:30-3:30
3:30-6:30
Please provide us with as much information as possible in regards to scheduling or necessary notes:
The more information you provide, the quicker we can get you scheduled!
How soon are you wanting to be enrolled?
ASAP
Summer (accepting for 2025)
Spring
Fall
Winter
Submit
Should be Empty: