SwimRVA Swim School Interest Form
Please fill out the information below.  This will help SwimRVA determine the best fit for you.  A Relationship Coach will be in touch with you within 48 hours to go over options and details about the program.
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Participant First Name *
Participant Last Name *
Participant Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian First Name
Parent Guardian Last Name
Email *
Phone Number *
Address (Optional)
Preferred Location (you may choose more than one) *
Captionless Image
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Preferred Days (Please choose at least 2) *
Required
Preferred Times (You may choose more than one) *
Required
How did you hear about us? *
Additional Comments/Notes
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