Private Lesson Request Form
Thank you for filling out a private lesson form. If you are in need of different lessons for multiple children, please fill out a separate form for each swimmer. It is our goal to match all private lesson requests with an available instructor. Upon receipt of your request, the Aquatic Coordinator will work to secure an instructor and contact you ASAP. Please note that we are currently running a waiting list, and it may take a bit to get your lessons scheduled. We will work as quickly as possible to find you a time. Rates are based on four, half hour lessons. Please make checks payable to CECS (Cape Elizabeth Community Services). Payment due prior to, or at the first lesson and given directly to your instructor.
Email address *
Swimmer 1 ($100) Name and Age *
Your answer
Swimmer 2 ($160) Name and Age
Your answer
Swimmer 3 ($180) Name and Age
Your answer
Preferred Day and Time Choice 1 *
Your answer
Start Date
MM
/
DD
/
YYYY
Preferred Instructor? or no preference *
Your answer
Describe current ability of the swimmer(s). Examples: non-swimmer, needs flotation, no strokes, stroke refinement. Multiple swimmers should be of similar ability. *
Your answer
Responsible Party *
Required
Contact Name *
Your answer
Town/City *
Your answer
Preferred Phone Number *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of CapeElizabeth.org. Report Abuse - Terms of Service