Swimmer's name *

First Name

Last Name

Swimmer's ability *

No ability

Beginner ability

Intermediate ability

Strong ability

Confident in all waters

Lesson location *

Backyard pool (write address below)

Ocean

Club pool (write which club below)

Other (write the desired location in the additional comments)

Ideal lesson length? *

20 minutes

30 minutes

45 minutes

60 minutes

Ideal lesson time *

Morning

Afternoon

Flexible

Parent/Guardian name *

First Name

Last Name