Private Swim Lessons Request Sheet
Clients Name (First and Last)
*
First Name
Last Name
Age
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date Requested
*
-
Month
-
Day
Year
Date
Parent/Guardian (if under 18)
First Name
Last Name
Are you a Member?
*
Yes
No
What are you interested in?
*
Private Swim Lessons
Semi-Private Lessons
If interested in Semi-Private, please list the name, age, and phone number of the other client. If not please leave this section blank.
Name
First Name
Last Name
Age
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What are your lessons goals? (Select all that are relevant)
*
Training
Safety
Learn the Basics
Improve Strokes
What is your current swimming ability? (ex. Can float with assistance, knows some strokes, can swim in deep end, terrified of water)
*
What days of the week are you available for lessons?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What times are you available for lessons? Please be as specific as possible.
*
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