Recurring Lesson Application
Thanks for your interest in enrolling your kiddo in private lessons at Little Kickers! We will place families onto our permanent schedule on a first come, first served basis. Please complete this form in full and create your Pike13 account to ensure a smooth enrollment process!
Parent Name
*
First Name
Last Name
Phone Number
*
Please enter a mobile phone number.
Email
*
Confirmation Email
example@example.com
How many kids would like to enroll?
*
Do you currently have one or more kiddos enrolled?
*
Please Select
No
Yes, I am adding a second
Yes, I am adding a third
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Does your child (or one of your children if you a registering multiple) have medical or adaptive needs?
*
Yes
No
Child Name
*
First Name
Last Name
Age
*
Please Select
5-7 months
7-9 months
9-11 months
1
2
3
4
5
6
7
8
9
10
11
12+
Round up if your kiddo is within a couple months of a birthday.
Medical/Adaptive Needs
Please use this space to let us know what kind of medical conditions or adaptive needs your kiddo(s) has so that we can prepare their instructor(s).
Second Child's Information
Child Two Name
First Name
Last Name
Child Two Age
Please Select
5-7 months
7-9 months
9-11 months
1
2
3
4
5
6
7
8
9
10
11
12+
Round up if your kiddo is within a couple months of a birthday.
Child Two Medical/Adaptive Needs
Third Child's Information
Child Three Name
First Name
Last Name
Child Three Age
Please Select
5-11 months
1
2
3
4
5
6
7
8
9
10
11
12+
Round up if your kiddo is within a couple months of a birthday.
Child Three Medical/Adaptive Needs
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Timing for Multiple Kiddos
Please let us know how we can schedule your kiddos by selecting from the options below. The more flexibility you having in timing, the sooner can process your request! **If your kids need to swim on different days, please complete separate registration forms!**
Multiple Kiddos Scheduling:
*
Direct Overlap: The exact same lesson time
Staggered: 15 minutes between start times
Back-to-Back
Any of the above
Multiple Kiddos Lesson Length:
30 Minute Lessons (2+ kids in the pool for private lessons with different instructors.)
30 and 15 Minute Lessons (2+ kids in the pool for private lessons at the same time with different instructors. 15 minute lesson for kids one and under!)
Lesson Length
Please let us know how we can schedule your kiddos by selecting from the options below. The more flexibility you having in timing, the sooner can process your request! **If your kids need to swim on different days, please complete separate registration forms!**
Select one:
30 Minute Lesson
15 Minute Lesson (kiddos one and under)
Instructor Preference
Please note, we can no longer honor requests for booking with a specific instructor. If you have an instructor requirement, we suggest booking drop-in lessons.
Instructor Preference
*
Female
Male
No Preference
OPTIONAL: Set your end date
Our lessons are ongoing, meaning you'll let us know when you're ready to withdraw. However, we've found that some families are only interested in lessons for a set period of time. If you already know when you'd like to withdraw, please indicate the FINAL month you'd like to be billed through and we'll set up your billing accordingly upon enrollment. We will contact you before that month to confirm your plans have not changed!
Please indicate the FINAL month you'd like to be billed through.
*
Please Select
N/A - We will withdraw when we're ready
January
February
March
April
May
June
July
August
September
October
November
December
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Please read thoroughly!
We would hate for you not to get a spot due to misunderstanding how we schedule and what our availability is! It will just take a quick few to read through the below!
Our schedule availability is dictated by kids graduating out of their lesson times!
Meaning, if your only availability is for an hour or two during our peak times, there’s a chance you may not be offered a spot during the registration window. The more time frames you can give us, the higher the likelihood of getting a spot!
Please be intentional with the days/times you are providing!
If you cannot accept the first time offered to you, our team will make an effort to offer you one more alternative time before asking you to resubmit your registration. It takes us a ton of work to coordinate lesson times, so please only mark down when you are actually available and let us know if that changes!
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Please select ALL the times that apply below!
What times are you available for lessons?
*
Weekdays 8AM-3PM
Weekdays 3PM-7:30PM
Weekends
Mondays 8AM-3PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 2PM-2:30PM
Mondays 3PM-7:30PM
Only enter times, no words. Separate time periods by a comma. Ex: 3:15PM-5:30PM, 7PM-7:30PM
Tuesdays 8AM-3PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 2PM-2:30PM
Tuesdays 3PM-7:30PM
Only enter times, no words. Separate time periods by a comma. Ex: 3:15PM-5:30PM, 7PM-7:30PM
Wednesdays 8AM-3PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 2PM-2:30PM
Wednesdays 3PM-7:30PM
Only enter times, no words. Separate time periods by a comma. Ex: 3:15PM-5:30PM, 7PM-7:30PM
Thursdays 8AM-3PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 2PM-2:30PM
Thursdays 3PM-7:30PM
Only enter times, no words. Separate time periods by a comma. Ex: 3:15PM-5:30PM, 7PM-7:30PM
Fridays 8AM-3PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 2PM-2:30PM
Fridays 3PM-7:30PM
Only enter times, no words. Separate time periods by a comma. Ex: 3:15PM-5:30PM, 7PM-7:30PM
Saturdays 8AM-1PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 12PM-12:30PM
Saturdays 1PM-6:00PM
Only enter times, no words. Separate time periods by a comma. Ex: 1:00PM-2:30PM, 3:15PM-5:30PM
Sundays 8AM-1PM
Only enter times, no words. Separate time periods by a comma. Ex: 8AM-11AM, 12PM-12:30PM
Sundays 1PM-6:00PM
Only enter times, no words. Separate time periods by a comma. Ex: 1:00PM-2:30PM, 3:15PM-5:30PM
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Third Party Billing
Please indicate whether you will be making use of funding from one of our partners or if you are a returning family with account credit to be applied to your first bill(s).
Alternative Funding
*
RMHS
Developmental Pathways
Hope Floats Scholarship
Account Credit (previously enrolled families)
N/A - We'll be paying for our own lessons
ACH Payment
Our billing system uses ACH (bank account) information rather than credit cards or other forms of payment. Please add your bank account information using the form below. If you chose not to fill out this information we will not be able to add you to our schedule! This form is completely secure and we will not store any of the information outside of this point of entry in our Pike13 scheduling & billing platform.
Name on Account
*
First Name
Last Name
Bank Name
*
Routing Number
*
Account Number
*
Once we confirm your lesson day and time slot do we have your permission to charge your account for lessons? If you select no, we will follow up with you upon confirmation of your enrollment.
*
Yes
No - PLEASE NOTE: We will not process your registration until we have payment on file.
Hope Floats Scholarship Donation
At Little Kickers, our desire is that every child learn how to be safe and have fun in the pool. We don’t want any child to be left out, and that’s why we partner with Hope Floats, an organization that works to connect low-income families with high-quality swimming lessons. Curious about the process? https://littlekickersco.com/little-kickers-scholarships/
Would you like to contribute to lessons for kiddos in need?
*
One time payment of $50
One time payment of $25
$10 per month
$5 per month
No, thank you!
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Create Your Pike13 Account
Head to Pike13 and create your account with us (if you haven't already) and sign the waiver. Click here to create your account and sign our waivers: https://littlekickersswimschool.pike13.com/
Confirm you've created your account and signed the waivers.
*
Yes
Policy Agreement
Click here to read our policies: https://littlekickersswimschool.pike13.com/pages/policies and sign below to accept.
I've have read and accept Little Kickers Swim School's policies.
*
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