Miss Sheila's Swim School Form
Parent Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you receive text at this number?
*
Yes
No
Swimmer's Name
First Name
Last Name
Swimmer's Birthday
-
Month
-
Day
Year
Date
Please select age and time
*
9:00 AM - baby and parent class (ages 1-3)
10:30 AM - (ages 4-6)
11:30 AM - (ages 7-17)
5:00 PM - (ages 18+)
Lessons and Pricing
*
5- 1 hour lessons $250
Private lessons $350
Please click yes if you will give permission to have photographs of your child taken
Yes
No
Payment: Deposit of $50 is required before scheduling balance is due first day of lessons
*
Cash-app (2thfrry) Sheila Holland
Venmo (SheliaHolland123) Sheila Holland
Cash
Checks (written out to Sheila Holland)
If you were referred by a friend please let us know who, so we can thank them!
First Name
Last Name
Submit Form
Should be Empty: