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.

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.
Parent Name*

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

Area CodePhone Number
Do you have a HAC JackRabbit account?

YesNo
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Today's Date - DO NOT EDIT

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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