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First Name

Last Name

Email

Phone number

Address

Street Address

City

How did you hear about us?

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Other / Referral

How many children do you have and their ages?

Swimming Level

Parent and Tot (Kids under 3-Years-Old)

Preschool (3-5)

Swimmer (5-12)

Rookie, Ranger, Star Patrol (5-12)

Bronze Levels (12+) *Subject to Lifesaving Society Pool Requirements

Fitness Swimmer (8+)

Adult Swimmer (16+)

Preferred time of day for lessons

Morning (930 AM - 12 PM)

Afternoon (12 PM - 4 PM)

Evening (4 PM -7 PM)

Preferred days of the week

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Days that do not work for lessons

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Type of Lessons

Semi-Private Lessons

Private Lessons

How many lessons a week you would like?

When would you like to begin lessons?

Additional Info to Provide

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Swimming Lessons

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Mom & Baby Lessons

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First Aid Lessons 

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Pool Party Lifeguard 

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