Swim Lesson Registration Form

Swim Lesson Registration Form
Parent Name

First NameLast Name
Email (for your receipt)
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Swimmer's Name

First NameLast Name
Swimmer #2's Name (If you have a second child that needs to sign up)

First NameLast Name
Swimmer #3's Name (If you have a third child that needs to sign up)

First NameLast Name
Swimmer's Age(s)
The available slots for this age range have been filled.
Lessons will be held Monday July 6, 7, 8, 10th. . You will be signing up for 4 days. Family swim will still be that Thursday, no swim lessons that day.

Ages 5 and under 5-6pm
Ages 6+ 6pm-7pm
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Swim Lessons
If you have multiple children that need to sign up, please include each of their names above. We ask you use the dropdown box below to choose the number of swimmers.

$55.00 Quantity

Total

$0.00

Debit or Credit Card

Choose from one of the PayPal options to make your payment.