Swimming Lessons Waiting List
Parent Name
*
First Name
Last Name
Childs Name
*
First Name
Last Name
Childs Current Age
*
Childs Date Of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
E-mail
*
example@example.com
Comfort/Skill Information
*
Is afraid/not comfortable submerging or getting face wet.
Is comfortable and will willingly put face in water or submerge
Can swim with floatation device/adult assistance
Can swim without a floatation device/adult assistance
Can pass YMCA Shallow water swim test
Can pass YMCA deep water swim test.
Preferred Lesson Type
Group
Private
Either
Submit
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