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* Indicates required question
Email
*
Your email
Child 1 Name
*
Your answer
Child 2 Name
*
Your answer
Child 3 Name
*
Your answer
Child 4 Name
Your answer
Child 5 Name
Your answer
Child 6 Name
Your answer
Child 1 Age
*
Choose
Under 1
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Adult
Child 2 Age
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Choose
Under 1
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Adult
Child 3 Age
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Choose
Under 1
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Adult
Child 4 Age
Choose
Under 1
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Adult
Child 5 Age
Choose
Under 1
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Adult
Child 6 Age
Choose
Under 1
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Adult
Parent/Guardian's Name
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Child 1 Swimming Ability
*
No experience
Comfortable around water but needs skill improvement
Can swim but needs stroke technique assistants
Child 2 Swimming Ability
*
No experience
Comfortable around water but needs skill improvement
Can swim but needs stroke technique assistants
Child 3 Swimming Ability
*
No experience
Comfortable around water but needs skill improvement
Can swim but needs stroke technique assistants
Child 4 Swimming Ability
No experience
Comfortable around water but needs skill improvement
Can swim but needs stroke technique assistants
Clear selection
Child 5 Swimming Ability
No experience
Comfortable around water but needs skill improvement
Can swim but needs stroke technique assistants
Clear selection
Child 6 Swimming Ability
No experience
Comfortable around water but needs skill improvement
Can swim but needs stroke technique assistants
Clear selection
Number of Lessons
*
1 Lesson
4 Lessons
8 Lessons
Location
*
My neighborhood pool (Address provided upon inquiry)
Your pool (Additional $20 travel fee)
Address (If we are doing lessons at your pool)
Your answer
Payment Option
*
Venmo (@lchealan)
Cash
Check
Apple Cash
Submit
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