Private Swim Lesson Request

Phone Number

Participant Age

Ability of Participant

Participant 2 Age (if applicable)

Ability of Participant 2 (if applicable)

Please choose your affiliation

Instructor Preference

Male

Female

No Preference

If you would like a specific instructor, please type in their name below.

Lesson Type

Private

Semi-Prviate (Must have partner of similar age and ability)

Lesson Package

Single Lesson

Five (5) Pack of 30 min lessons

Preferred date to begin lessons (Please allow at least 6-8 weeks before your start date)

Additional Comments

Preferred Days and Times

Friday and Saturday Lessons must be scheduled around group lessons so time and space is limited.

Preference example: Saturday 12:00pm, Tuesday/Thursday 7:30pm.

First Preference

Second Preference

Third Preference

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