Learn for Joy Swim Lesson Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google.