Private Swim Lesson Interest
Campus Recreation Services - Aquatics
360-650-4094 		#New Form
Private Swim Lesson Interest Form
* Required
Swim Participants Information
Name:   Age:  
Email:   Phone:

Swimming Ability (select one) *
True Beginner (no previous swim lesson experience)
Fearful Beginner (has a fear of the water)
Intermediate (comfortable putting face in water, some independent swimming: front crawl, doggy paddle)
Itermediate Advanced (knows a few strokes, can swim but needs form work and endurance)
Advanced (knows most of the strokes, needs technique and endurance work)
Other (if other, please explain below)
Other:  

What are your swimming goals? (short answer) *

Desired Start Date *

What days are you available? (select all that apply) *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What times would you prefer? (select all that apply) *
Morning (Open-10:00am)
Mid-Day (10:00am-2:00pm)
Afternoon (2:00pm-5:00pm)
Evening (5:00pm-Close)
Other (explain below)
Other:  

Please provide any additional pertinent information. (short answer)
 
Signatures and Attachments
The submitter may optionally enter their email address below. Press SUBMIT to send it.