Private Swim Lesson Sign Up
Thank you for your interest in our private swim lesson program at the Shepherd University Wellness Center! Please complete the form below and we will contact you to accommodate your request.

If you have any questions please call our Aquatics Coordinator at 304-876-5440.

Name of Student: *
Your answer
Student Date of Birth: *
Your answer
Email Address:
Your answer
Phone Number: *
Your answer
Mailing Address: *
Your answer
Does the student have a fear of water?
Do you prefer a male or female instructor?
What are the goals/skills the student would like to accomplish with these lessons?
Your answer
Please list some days and times of the week that work best for you to schedule a lesson:
Your answer
Are there any special considerations/situations we should be aware of?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms