We’re excited you're interested in swim lessons!
Submitting this form will automatically place your child on our waitlist for private swim lessons. You will receive a confirmation from our staff within 3 business days of submitting this form. Please note: placement from the waitlist depends on instructor availability. If we are unable to offer you a spot within 3 months, we will follow up to confirm if you’d like to remain on the waitlist. Thank you for your patience — we look forward to welcoming your swimmer to the program soon!
Parent Name
*
First Name
Last 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)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Times available for lessons
*
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
3:30pm
4:00pm
4:30pm
5:00pm
Other
What month are you interested in swim lessons?:
*
Please list any upcoming vacation dates:
*
How did you hear about our swim lesson program:
JCC Staff Member
JCC Member
Word of Mouth/ Friend Referral
Email
Print Advertisement
Online Search
Social Media
Other
If you selected "Word of Mouth" to the previous, please share the person's name:
If you selected "Other" to the previous, please specify:
Are you a JCC Member?
*
YES
NO
Submit
Should be Empty: