Adult Swim Program Interest

Interested in Adult Swim Programs
Form Enable Date

MonthDayYear
Date
Thank you for your interest!
We are not accepting swim lesson enrollment requests at this time.

We will begin accepting enrollment requests for the spring session on Tuesday, February 10th at 12:00AM
Thank you for your interest!

Your answers will help us with the registration process.
Your Full Name*

First NameLast Name
Your E-mail*
Your Phone Number*

Area CodePhone Number
I am a*

MemberNon-member
Do you have a HAC JackRabbit account?

YesNo
I am interested in*

Adult Swim Mechanics ClinicsPrivate / Semi-Private Lessons
What days/times work best for you? Select all that apply below.
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Current skill level*

I have little or no experienceI have some experienceI am an experienced swimmer and would like guidance with strength and/or technique
Do you have any medical or behavioral needs that we should be aware of that may affect your swim lesson participation? If so, please briefly describe.
Additional comments, questions, or goals
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TODAYS DATE - DO NOT EDIT

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Date
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Interested in Adult Swim Programs