Private Swim Lesson Interest Form
Please complete this form and an aquatics department coordinator will reach out with more information.
Swimmer Name
*
First Name
Last Name
Swimmer Age (or adult):
*
Parent/Guardian Name (if applicable):
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred lesson location:
*
Wilkes-Barre
Pittston
Swimmer's level of ability (or best guess):
*
Non-swimmer
Beginner
Some Ability
Advanced
Swim lesson goal:
*
Overcome fear of the water
Learn to swim for safety and fun
Triathlon
Stroke development for swim team
Other
Other important information:
Submit
Should be Empty: