Private Lesson Request

Private Swim Lesson Request

Please fill out this form to request private lessons at Plunge San Diego. We will reach out once a lesson slot in your preferred schedule becomes available. Thank you!
Parent Name*

First NameMiddle NameLast Name
Student Name*

First NameMiddle NameLast Name
Student Birth Date*

MonthDayYear
Student Gender*
E-mail*
example@example.com
Mobile Number*
Has the student done swim lessons before?*

YesNo
Please describe the students current swim level and skills:*

Our private swim lessons are typically held M-Th in the afternoons/evenings, and Friday-Sunday mornings. Please list any days or times you'd like to request:*

	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
8am-12pm
12pm-3:30pm
3:30pm-7pm

Requested Start Date*

MonthDayYear
Date
Requested End Date (if none leave blank)

MonthDayYear
Date
Does the student have any disabilities or special needs we should be aware of to provide the best possible swim experience?*

YesNo
If yes, please briefly describe any accommodations or support that may be helpful: Your response will help our staff ensure a safe and supportive environment. All information is kept confidential.
Should be Empty:

Private Swim Lesson Request