Private Lesson Registration Name Swimmer's Details Let us know your information, so we can get back to you Swimmer First Name * Swimmer Last Name * Age of Swimmer * Highest Level Swimming Completed * PreSchool 1 PreSchool 2 PreSchool 3 PreSchool 4 PreSchool 5 Swimmer 1 Swimmer 2 Swimmer 3 Swimmer 4 Swimmer 5 Swimmer 6 Rookie Ranger Star Bronze Medallion Bronze Cross Unknown has your child participated in swimming before? if so, what level was completed? What Lesson were you looking for * Parent & Tot 1 Parent & Tot 2 Preschool 1 Preschool 2 Preschool 3 Preschool 4 Preschool 5 Swimmer 1 Swimmer 2 Swimmer 3 Swimmer 4 Swimmer 5 Swimmer 6 Rookie Patrol Ranger Patrol Star Patrol Bronze Medallion Bronze Cross Unknown select the lesson level Preferred Date Block # 1 Block # 2 Block # 3 Notes List out any skills you would like worked on. Medical Conditions? * does your child have any medical conditions we would need to be aware of? if so list them here Helper in water? * Will your child require a helper in the water with them? if so what is the helpers name and relation to the child? Parent/ Guardian Details Let us know your information so we can inform you of updates or schedule changes Parent/ Guardian 1 Name * Parent/ Guardian 2 Name Email Address * Other Email Address Phone Number * Other Phone Number
