Samantha's Swimming Adult Lesson Request Form
This form is for those who are interested in signing up group adult lessons. Please remember, this form is not signing you up for lessons, it is to receive priority emails from us when we are scheduling. By filling out your information here, you will be notified when schedule announcements are be made. Swimming lessons are first come first serve.
What type of client are you?
Returning client
New client
Other
Swimmer Information
Name
First Name
Last Name
Phone Number
Please provide a number to receive text.
Email
*
example@example.com
Please tell us who referred you:
Please Select
Facebook
Google
A friend
If referred by a friend, who can we thank?
Please explain any experience you have with swimming as well as what you hope to get out of lessons.
Submit
Should be Empty: