Swim Lesson form

Please circle time you’d like swim lessons:          

Afternnon - 2:30 - 3:00pm                Evening 6:00 - 6:45pm 

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?

_____________________________________________________________________________________

_____________________________________________________________________________________

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Please attach a check for $55 (member) or $65 (non-member) made out to Christina Ashmen and

return to the front desk during pool hours.