2. First and Last Name*
3. Phone*
4. Email*
6. Swimmers Name*
7. Swimmers Age*
9. Best day(s) of week for lessons*

   1. Monday
   2. Tuesday
   3. Wednesday
   4. Thursday
   5. Friday
   6. Saturday
   7. Sunday
10. Best time of day for lessons*

    1. Morning (9-11a)
    2. Mid-day (11a-6p)
    3. Evening (6-8p)
11. How many lessons per week do you prefer?*
13. Instructor preference*

    1. Male
    2. Female
    3. No preference
14. Goals*
16. Any other important information*
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field