Learn for Joy Swim Lesson Request

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Thank you for your interest in swim lessons. Please complete the form below and Stephanie will get back to you to discuss your responses and options.

Your First Name *

Your Last Name *

Contact Phone Number (cell phone preferred) *

Contact Email Address *

Do you have your own personal pool available for lessons at the address provided? (Not a community pool) *

Yes

Address/location of swim lessons (please include street and town information) *

How many students will be participating in the swim lesson? *

Other:

What are the ages of students participating in the swim lesson? (Choose all that apply and ages of students at time of when lessons begin) *

6 months - 12 months

13 months - 24 months

2 years - 4 years

5 years - 7 years

8 years - 11 years

12 years - 15 years

16 years and up

Required

What is the length of lessons you are interested in? *

30 minutes for one student

60 minutes for one to four students

Other:

What days/times are you available for the start time of lessons? (Check all that apply)

Morning (8 am - 11 am)

Midday (11 am - 2 pm)

Afternoon (2 pm - 4 pm)

Monday

Tuesday

Wednesday

Thursday

Friday

Any other additional information you would like to share with Stephanie.

Submit

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