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.