Swim Lessons

Your first name

Your last name

Email

Phone

Address

City, State, Zip

Private or Group Lessons

Private

Group

Are you a member or non-member

Member

Non-Member

How many children are you signing up for lessons?

1

2

3

What session are you signing up for?

Session 5 (July 21- August 1)

Child's Name

Child's Age

Brief overview of Child's swimming ability

Emergency Contact Full Name and Relation to Child

Emergency Contact Phone Number

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

Pocahontas Swim Club

Summer phone: (260)209-3158
Off Season phone: (260)450-2610

Physical:

3020 Ojibway Trail

Fort Wayne, IN 46809

Mailing:

PO Box 11553

Fort Wayne, IN 46859

12:30 – 8:30 Daily, Memorial Day through Labor Day

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