Private Swim Lesson Registration Form

Our pools at our Carroll County locations are outdoor only! This means that the earliest we'll be able to start our swim lessons is late May/early June. If you are looking for an indoor option please check out our Coppermine ACAC location: https://www.gocoppermine.com/health-fitness/timonium/aquatics/

Parent/Gaurdian Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Participant's Name*

First NameLast Name

Birth Date

MonthDayYear

Please give a brief description of your chid's swim ability/experience

Lesson Choice

Private Swim Lesson (non-member)$36.00

30 minute private classes

Quantity

Private Swim Lessons (swim club members)$32.00

30 minute private lessons for swim club members

Quantity

Semi-private Lessons (non-member)$24.00

30 minute semi-private lessons. Must sign up with 1 or 2 other children listed below

Quantity

Semi-Private Lessons (swim club members)$20.00

Semi-Private Swim Lessons for swim club members. Must sign up with 1 or 2 other children listed below.

Quantity

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

If you are enrolling in semi-private lessons please list the names of the other students you wish to have lessons with below

Name

First NameLast Name

Name

First NameLast Name

Please select the following options to better assist in scheduling your lessons. Someone will be in contact to set up your exact schedule.

Preference

AM lessonsPM lessons

Please list all days of the week that work for you

Prefered Start Date

Date

Private/Semi-Private Swim Lesson Registration

Thank you for your interest in private/semi-private lessons. Once we receive this form, we will do our best to match you up with an instructor that fits your needs and preferred times.