SwimZin Mobile Swimming Lessons Registration Form
Thank you for your interest in taking swimming lessons with SwimZin Mobile Swim School! Please fill out the  form as completely as possible. Once the form is completed, you will be contacted by swim instructor Phaedra to confirm your registration.
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Email *
Contact Information
Who is inquiring about lessons?
First Name *
Last Name *
Phone *
Address *
Emergency Contact Information *
Please list full name of contact, as well as relationship to the swimmer(s), and emergency contact phone number
How Did You Hear About Us? *
If you selected "referral/word of mouth/other" in the question above, please list how you heard about us and/or who referred you:
Allergies and Health-Related Issues *
Please list known allergies and health-related issues below. If none, type "N/A"
Pool Preference *
*LA Fitness for youth 14 and older*
Are the lessons for... *
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