Youth Swim Lesson Interest Form

Youth Swim Lessons Enrollment Request Form
On what date would you like to enable this form?

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

Enrollment requests for our Fall 1 session will open on Tuesday, August 19th at 12:00AM.
Thank you for your interest!

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

First NameLast Name
Parent e-mail*
Parent phone number*

Area CodePhone Number
utm_source
utm_medium
utm_campaign
utm_term
Today's Date - DO NOT EDIT

MonthDayYear
Date

I understand that registration in my desired programs is not ensured and that I will be contacted by the HAC Aquatics Department to confirm swim lesson enrollment and cost.
Additional comments, questions, or goals
Should be Empty:

Youth Swim Lessons Enrollment Request Form