Swim Lessons Interest List

Swim Lessons Interest List

Thanks for your interest in swim lessons. Please complete the form below, in order for us to connect you with an available swim instructor when we are able to accommodate new swimmers into the swim lessons program. Please allow for 72 hours before a staff can connect with you. Thank you.
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Phone Number*
Please enter a valid phone number.
Best time to call:*
Child's Name*
Child's Age*
2nd Child's Name (if applicable)
2nd Child's Age (if applicable)
Additional Children Information
Days available for lessons (click all that apply)*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Times available for lessons*

11:00am11:30am12:00pm12:30pm1:00pm1:30pm2:00pm3:30pm4:00pm4:30pm5:00pmOther
What month are you interested in swim lessons?:*
Please list any upcoming vacation dates:*
How did you hear about our swim lesson program:
Who referred you to our swim lesson program:
Are you a JCC Member?*

YESNO
Should be Empty: