Swim Lesson Form

General Information
Parent/Guardian Name
Name of Subdivision/Club
Address
City, State Zip
Home Phone
Cell Phone
E-mail
Child Information
Child's Name
Childs Age
Has your child been in swimming lessons before?
	Yes No
If YES, what level did our child reach in swim lessons?

Please give a brief description of your child's swimming abilities:

Medical Information and Emergency Contact
Does the child have any allergies or illnesses?
	Yes No
If YES, what are the allergies or illnesses?

Emergency Contact
Relationship to Child
Phone number
Work or cell number

Based on the Swim Lesson Criteria, what level would you place your child in swim lessons:

I would like to register my child for:
	Group Lessons Semi-Private lessons Private lessons
Group Lessons are held for 1/2 hour time segments. Classes are offered in the mornings or early afternoon between the hours of 10:00am -1:00pm and in the evenings between the hours of 5:00pm-7:00pm. Classes are scheduled based on instructor availability and number of students enrolled. A member of SwimAtlanta Pool Management will contact you about the swim lessons times. Would you prefer: Morning/Early Afternoon or Evening Semi-Private and Private Lesson Times can be scheduled any time during the day.
If you are interested in Semi-Private or Private lessons, what time would you prefer to schedule these lessons?

If you are interested in Semi-Private or Private lessons, what time would you prefer to schedule these lessons? Refer to the previoous page for dates and times.
Session 1 Session 2 Session 3 Session 4 Session 5
How many lessons would you like to schedule?

Comments

Swim Lesson Form

General Information

Child Information

Medical Information and Emergency Contact