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Swim Lessons
Your first name
*
Your last name
*
Email
*
Phone
*
Address
*
City, State, Zip
*
Private or Group Lessons
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Private
Group
Are you a member or non-member
*
Member
Non-Member
What session are you signing up for?
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How many children are you signing up for lessons?
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1
2
3
Child's Name
*
Child's Age
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Brief overview of Child's swimming ability
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Emergency Contact Full Name and Relation to Child
*
Emergency Contact Phone Number
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Preferred Hospital
*
Doctor's Name
*
Doctor's Phone Number
*
Anything else you would like us to know?
In the event of an emergency, by signing this I authorize medical care to be provided for my child/children as deemed necessary.
*
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Please select your membership status, type of lesson, and how many children are signed up
*
Member Private Lessons
$225
Member Group Lessons
$125
Non-member Private Lessons
$265
Non-member Group Lessons
$180
Proceed to Checkout
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