Swim Lesson Questionnaire

Please fill out the form below to share more about your swimmer so that we can make their experience in our swim program positive, supportive, and fun!

Swimmer's First & Last Name(Required)

First Last

Swimmer's Birthdate(Required)

Emergency Contact First & Last Name(Required)

First Last

Emergency Contact Phone Number(Required)

Tell us about your child's previous swim experience:(Required)

What are your goals for your child's swim lessons?(Required)

Is your child toilet-trained?(Required)

Yes

Does your child have any medical needs that we should know about?(Required)

Please provide the name of the person who will be accompanying your child(ren) to swim lessons:(Required)

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Swim Lesson Questionnaire

Swim Lesson Questionnaire

weekly schedule