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
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 only
Spring
Fall
Winter
Submit
Should be Empty: