Swim Lessons Interest

Interested in Swim Lessons
Thank you for your interest! Your answers will help us with the registration process.
Who would the lessons be for? *

Me (adult) My child(ren)
Your Full Name *

First Name Last Name
Your E-mail *
Your Phone Number *

Area Code Phone Number
Zip Code
I am a *

Member Non-member
I am interested in lessons for the *

Summer Fall Winter Spring
I am interested in *

Group Lessons (Ages 30 months+) Private / Semi-private Lessons (Ages 30 months+) ISR (Infant Swimming Resource) (Ages 6 months - 6 years only) Little Seahorses (Infant Toddler with Parent)
utm_source
utm_medium
utm_campaign
utm_term

Swimmer's Name *

First Name Last Name
Swimmer's Age *
Has he or she enrolled in HAC swim lesson before? *

Yes No
This swimmer can *

Belly float with face in water Back float Swim across pool on belly with arms and legs moving Swim across pool on back with arms and legs moving Swim freestyle with side breathing Tread water Jump into deep water Dive Swim breaststroke Swim more than one length of the pool unassistend No experience
Add another swimmer
Swimmer's Name *

First Name Last Name
Swimmer's Age *
Has he or she enrolled in HAC swim lesson before? *

Yes No
This swimmer can *

Belly float with face in water Back float Swim across pool on belly with arms and legs moving Swim across pool on back with arms and legs moving Swim freestyle with side breathing Tread water Jump into deep water Dive Swim breaststroke Swim more than one length of the pool unassistend No experience
Add another swimmer
Swimmer's Name *

First Name Last Name
Swimmer's Age *
Has he or she enrolled in HAC swim lesson before? *

Yes No
This swimmer can *

Belly float with face in water Back float Swim across pool on belly with arms and legs moving Swim across pool on back with arms and legs moving Swim freestyle with side breathing Tread water Jump into deep water Dive Swim breaststroke Swim more than one length of the pool unassistend No experience
Add another swimmer
Swimmer's Name *

First Name Last Name
Swimmer's Age *
Has he or she enrolled in HAC swim lesson before? *

Yes No
This swimmer can *

Belly float with face in water Back float Swim across pool on belly with arms and legs moving Swim across pool on back with arms and legs moving Swim freestyle with side breathing Tread water Jump into deep water Dive Swim breaststroke Swim more than one length of the pool unassistend No experience
What days work for you? *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
And times? *

Early mornings (before 8:00 am) Mornings (8:00 am - 12:00 pm) Afternoons (12:00 pm - 4:00 pm) Evenings (4:00 pm - 7:00 pm)
Do these days and times work for all swimmers listed? *

Yes No
Please explain:
Additional comments, questions, or goals
Preferred length of lessons

15 minutes 30 minutes
Should be Empty: