Adult Private Swim Lesson Interest Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Participant Gender
Participant Age
*
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Next
What is the participants swimming experience?
*
Can the participant
*
Float on their front or back
Perform front crawl (freestyle)
Jump in water without holding their nose
None of the Above
Desired Number of Lessons
*
4 ($80)
6 ($100)
Does the participant need a guardian/paraprofessional in the water?
*
Yes
No
Other
Does the participant have any preferred teaching methods?
*
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What are the goals of the participant?
*
What days and times work best for you?
*
Any other feedback/requests?
Submit
Should be Empty: