Swimming Lessons Waiting List

Swimming Lessons Waiting List
Parent Name*

First NameLast Name
Childs Name*

First NameLast Name
Childs Current Age*
Childs Date Of Birth*

MonthDayYear
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 submergeCan swim with floatation device/adult assistanceCan swim without a floatation device/adult assistanceCan pass YMCA Shallow water swim testCan pass YMCA deep water swim test.
Preferred Lesson Type

GroupPrivateEither
Should be Empty: