EmailMe Form - Private Swim Lessons Application

Private Swim Lessons Application
If you are interested in having a private swim lesson(s) at the Asotin County Family Aquatic Center, please fill out the following application

Student Name *

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Date of Birth *

YYYY

Phone Number *

###

####

Swim Lessons Level

Parent-Tot

Preschool 1

Preschool 2

Preschool 3

Land Lubbers (Lvl1)

Deckhands (Lvl 2a)

Sea Dogs (Lvl 2b)

Swabbies (Lvl 3)

First Mates (Lvl 4)

Capn's (Lvls 5 & 6)

Adult Beginnner

Adult Stroke Improvement

Please indicate what level of instruction you are interested in. If you do not know which level is the best option, please leave this section blank.

Guardian/Main Contact

If Student is under 18

Prefix

First

Last

Suffix

Relationship to Student

Email

Number of lessons you would like to have *

Do you have a preference for day(s) of the week?

Do you have a prefrence for time(s) of day

AM/PM

Do you have a prefrence for time(s) of day

AM/PM

Additional Comments

I understand that the cost of Private Lessons is $18 per half hour session,or $30 for 2 students, and that payment is required prior to the lesson taking place. I further understand that I may choose to purchase multiple sessions in advance, and that any failure to appear on *

Agree

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