Private Swim Lesson Request

Please Use Our Most Updated Form at https://www.palatineparks.org/private-swim-lessons-request-form/

This Form Is No Longer In Use
For more information please contact Jessica Paneral.
Contact Name*
Phone Number
Email
Student Name
Age
Preferred Instructor
Approximate Level (If Known)
Preferred Day(s) (Choose All That Apply)

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Preferred Time(s) (Choose All That Apply)

Morning (8am-11am)Mid-Day (11am-3pm)Afternoon (3pm-6pm)Evening (6pm-9pm)Other
Goals for private lessons
Previous swim experience
Notes
Should be Empty:

Please Use Our Most Updated Form at https://www.palatineparks.org/private-swim-lessons-request-form/