Swim Lesson Sign Up Form

Please complete the form below and email to the swim lesson instructor listed on the private lesson or group lesson tab above.  If registering multiple children, please complete a separate form for each child.

Swim Lesson Form

Please circle your preferred time you would like swim lessons:          

                 Weekday:       Mornings           Afternoons              Evenings

Are you interested on Group or Private Lessons?   Group                     Private                   

Parents Name _________________________________

Best number to be reached  during the day ______________________________

Email address __________________________________________

Are you a current Haddontowne Swim Club Member?   Yes                No               

Childs First Name ___________________ 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 and 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?

_____________________________________________________________________________________

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