Swim Lessons Registration Form (Spring 2019)
Brandeis University Swimming and Diving Lesson Program
Email address *
Parent(s) Name(s) *
Your answer
Address (Street, Town/City, and Zip Code) *
Your answer
Best Phone Number for Communication *
Your answer
Please Choose Frequency of Lessons *
If choosing Flex Dates, please select the sessions you are able to attend:
Please Choose Preferred Class Time *
Required
Child #1 (Name and Age) *
Your answer
Previous Lesson Experience? *
We prefer our instructor be: *
Child #2 (Name and Age)
Your answer
Previous Lesson Experience?
We prefer our instructor be:
Child #3 (Name and Age)
Your answer
Previous Lesson Experience?
We prefer our instructor be:
Child #4 (Name and Age)
Your answer
Previous Lesson Experience?
We prefer our instructor be:
Child #5 (Name and Age)
Your answer
Previous Lesson Experience?
We prefer our instructor be:
A copy of your responses will be emailed to the address you provided.
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