Interest Form for Private and Semi-Private Swim Lessons

Name of swimmer*
First Last
Name of second swimmer
First Last
(if requesting semi-private lessons, i.e. for more than 1 swimmer)
Name of third swimmer
First Last
(if requesting semi-private lessons for 3 swimmers)
Age*
Please enter a number from 1 to 100.
Parent's Name
First Last
(if swimmer is under 18)
Email*
Phone Number*
Alternate Phone Number
Preferred Start Date*
Date Format: MM slash DD slash YYYY
Total Number of Lessons*
Please enter a number from 1 to 100.
Do you have a preferred instructor? If so, please specify here:
Goals (what do you want to achieve in your lessons?)*
Notes or Comments
What days and times are you available for lessons? Each lesson is 30 minutes long*
Name of person filling out this form*
First Last