Swim Lessons Registration

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Grafton Community Pool

711 Jett Street Fredericksburg, VA 22405

graftonpool@hotmail.com

Parent or guardians Name *

Email *

Phone Number *

Swimmer's Name *

Swimmers Date of Birth *

YYYY

Which sessions will your swimmer attend? *

Session 1: June 16, 18, 20

Session 2: June 23, 25, 27

Session 3: June 30, July 2 and 3

Session 4: July 7, 9, 11

Required

Preferred Time *

11:15 AM - 11:55 AM

12 PM - 12:40 PM

Required

Swimmer is able to do the following: *

Put face in water

Float on back for 10 seconds

Tread water for 15 seconds

Swim 5 feet

Swim with face in water for 10 feet

Jump in from wall with assistance

Jump in from wall and swim 5 feet

None of the above

Required

I understand that my sessions are not booked until payment is made. Each session is $75. Payment can be sent using Venmo or made in person with check or cash. *

Yes

Required

Submit

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