Swim Lessons Registration

Swimming Lessons by Rebekah
Parent(s) Name(s)*
Email Address*
Contact Number*
Do you receive Text at this number? Only used for notifications, ie inclement weather*

YesNo
Swimmer's Name*
Swimmer's Gender*

MaleFemale
Swimmer's Birthday*
Do you have a pool for lessons?*

YesNo
If yes, will lessons take place at a community pool or home pool?*
Pool address: Please list community pool address or area. If you do not have a pool please write “I will come to you”*
Please Select your Preferred Days*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
When are you available? We do lessons from 9am-7pm every single day except Sundays we start lessons at 11am.*
There is a $30 registration fee, per Swimmer, due for an assessment. This can be paid by Venmo, PayPal, Cash App, or Zelle Session Fee is also due on the first day of lessons.
We occasionally take pictures of the kids in action swimming or doing other activities for our Facebook Page. We hope to use these to keep parents and the community up to date on the happenings.
Please click yes if you WILL give permission to have photographs of your child taken*

YesNo
How did you find us?*

Google/Other search engineFacebookFriendOther
If you were referred by a friend please let us know who, so we can thank them!
Thank You!
Should be Empty:

Swimming Lessons by Rebekah