Private Swim Lesson Request Form

Contact Name *
Contact Email Address *
Phone - ### - ### ####
Name(s) of Participant(s) *
Age range of attendees:
(Must be at least 3 years old) *
3-6 years old 7-10 years old 11-13 years old Teen Adult
What would you like your lesson to focus on and/or please indicate your swimmer's ability level? *
Instructor preference, if any? *
What time of day works best? *
Morning (8:30am-9:30am) Afternoon (2pm-4pm) Early Evening (4pm-7pm)
Which day of the week works best? *
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Is there anything else you would like the head swim lesson instructor to know prior to contacting you?