Swim Lesson Registration Form Parents or Gardians Name(s) Address Cell Phone Home Phone Work Phone E-Mail Swimmers Name(s) and Age Emergency Contact Name Relation Phone Number Swimming experience and ability Goals Additional pertinent information (i.e. learning disabilities, physical limitations, etc.) : For private and semi-private lessons only: Please list three preferred days and times in order of preference: 1) Preferred days and times 2 2) Preferred days and times 3 3) Number of lessons per week Teacher request *We will do our best to meet these requests; however we can guarantee instructors and their specific availability. How did you hear about us?
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