Private Swim Lessons Request Form

"*" indicates required fields

For more information please contact Jessica Paneral.

Name*

First Last

Email*

Phone*

Student Name

If not requesting for yourself.

First Last

Age

Preferred Instructor

If Applicable

Approximate Level

If Known

Preferred Location*

Choose All That Apply

Birchwood Pool

Eagle Pool

Family Aquatic Center

Harper (Indoor Pool)

Preferred Days*

Choose All That Apply

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred Time*

Choose All That Apply

Morning (8am-11am)

Mid-Day (11am-3pm)

Afternoon (3pm-6pm)

Evening (6pm-9pm)

Goals For Private Lessons

Previous Swim Experience*

Additional Comments

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