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Swim Lesson Sign-up Form

 

Swim Lesson form

Please circle time you’d like swim lessons:          

AM – 10:30 – 11am                   PM – 5:50 – 6:30

If you’d like a lesson from 7:30 – 8pm please make a note of it at the bottom of this form and if we are

able to we will try and put together a late evening group.

Please circle the session you are signing your child up for (only circle the current session a form will be

filled out for each session you choose to sign your child up for):                

session 1       session 2        session 3

Parents Name _________________________________

Best number to be reached  during the day ______________________________

Email address __________________________________________

First Name of Child ___________________ last Name ________________________

Age __________ birth date _______________ has your child taken swim lessons before?_____

If yes were and when? ______________________________________________________

Please answer the following questions so we can put your child in the right group level...

Does your child have any fear of the water? ________________________________________

Can your child put his/her face in the water? _______________________________________

Can he/she blow bubbles in the water? ____________________________________________

Can he/she float? _____ if yes front back or both? ___________________________________

Can he/she tread water? _______________________________________________________

Can he/she swim on their own at all, if so how far? __________________________________

What is your goal for your child to accomplish from these lessons?

_____________________________________________________________________________________

_____________________________________________________________________________________

________________________________________________________________

Please attach a check for $50 (member) or $60 (non-member) made out to Christina Ashmen and

return to the front desk during pool hours.