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4-Week Group Lessons
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Childs Name
Childs D.O.B
Age
Gender
Male
Female
Choose your child's swim level
Beginner
Intermediate
Advanced
Does your child have any fear or anxiety around the water
Yes
No
Can your child put their face in the water?
Yes
No
Can your child swim unassisted?
Yes
No
Can your child take a independent breath while swimming?
Yes
No
Any previous swim lesson experience?
Yes
No
What distance can your child swim?
Half Pool
Full Pool
Neither
Parent/Guardians Name
Are you an employee?
Yes
No
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Work Phone
Cell Phone
Email
*
Member
$190/per child
I'm not a member
Non-Member
$220/per child
I'm a member
What session would you prefer
Session 1 (March 11 - April 5)
Session 2 (April 8 - May 3)
Session 3 (August 5 - August 30)
Session 4 (September 2 - September 27)
Lessons are offered in a 4-week format, one 30-minute lesson per week.
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:00pm (Friday)
4:30pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:00pm (Friday)
4:30pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:00pm (Friday)
4:30pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:30pm (Friday)
4:00pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:00pm (Friday)
4:30pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
5:00pm (Tuesday)
5:00pm (Friday)
10:00am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:30pm (Friday)
4:00pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:30pm (Friday)
4:00pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:00pm (Friday)
4:30pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
4:00pm (Tuesday)
4:30pm (Tuesday)
4:00pm (Friday)
4:30pm (Friday)
9:00am (Saturday)
9:30am (Saturday)
Choice what time you would like the sessions
5:00pm (Tuesday)
5:00pm (Friday)
10:00am (Saturday)
Choice what time you would like the sessions
5:00pm (Tuesday)
5:00pm (Friday)
10:00am (Saturday)
Choice what time you would like the sessions
5:00pm (Tuesday)
5:00pm (Friday)
10:00am (Saturday)
How would you like to pay? (Non-Members must fill out a credit card auth form, that will be sent)
*
House Account **Preferred**
Check (Check must be brought in to hold spot) | Must be paid in 48 hours to hold
Cash | Must be paid in 48 hours to hold
Credit Card | Must be paid in 48 hours to hold
Payment must be made to ensure your spot
Signature
Clear Signature
Waiver | I accept full responsibility for my use of any apparatus, appliances, facility privileges, or service whatsoever, owned and operated by this club, directors, officers, employees, representatives, and agents harmless from any loss, claim, injury, damage or liability sustained or incurred by myself, my family or others under my supervision or control resulting therefrom. Also, I agree that the information above is accurate and complete. I also understand and acknowledge that photos/videos may be taken for publicity/marketing purposes. I also give my authorization for any photos or video footage of myself or my minor child to be used in this fashion.
Date / Time
Date
Time
Promotional Code (Optional)
Submit