Request for Private In-Home Or Adult Lessons

Parent or Guardian First Name

Parent Last Name

Child's Name

Child's Age

Second Child's Name

Second Child's Age

Private Pool Location

Pool Address

Ideal Swim START DATE (If flexible, please give options)

Ideal Swim LESSON TIME (If flexible, please give options).

Type of Swim Lesson

Swim Lesson Duration

Lesson Days (Mon-Thur ONLY)

Number of Weeks (Highly recommend 6 weeks for All)

Email Address

Best Phone Number

Please give me a brief explanation of the aquatic history of your child/children or of yourself if interested in lessons:

Please add anything I didn't ask. For example anything special about your child/ children or yourself. What are your goals, any fears, special requests, or any questions or concerns you may have ! I willdo my best to make sure you have a great experience and outstanding results.

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