Name *

First Name

Last Name

Phone

(###)

###

####

What swim levels are you and your family interested in. Select all that apply. *

Baby (2mths-3.5 years)

Level 1 (3.5-5.5 years - afraid)

Level 2 (3.5-5.5 years - Not Afraid)

Big Kid Level 1 (5.5+ years, Afraid)

Big Kid Level 3 (5.5+ years, Intermediate - Advanced)

Private 30 min

Private 45 min

Adult Class

When would you prefer to have lessons? Select all that apply

Monday Mornings

Monday Afternoons

Tuesday Mornings

Tuesday Afternoons

Wednesday Mornings

Wednesday Afternoons

Thursday Mornings

Thursday Afternoons