Private Swim Lesson Request Form

First Name:

Last Name:

Student age:

First Name:

Last Name:

Contact email:

Contact Phone:

Swimming ability:
(beginner, competitive, etc.)

Swimming goals:
(learn to swim, triathlon training)

Best Available Times:
(Note: lessons take place only during open pool hours, please see schedule below and check your preferences)

Monday, Wednesday, Friday 6 – 10 a.m.
Tuesday, Thursday 8 – 10 a.m.
Monday through Friday 11:30 a.m. – 1 p.m.
Monday through Thursday 4 – 6 p.m.
Saturday and Sunday 1 – 4 p.m.

Additional Info:
(Gender preference for instructor, special needs, etc.)

In order to help prevent abuse of this form, please enter the red letter from the image below:

Private Swim Lesson Request Form

Student Information:

Parent/Guardian Information: