Swim Lessons Registration Form (Spring 2023)
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Email *
Parent(s) Name(s)
Name (for adults interested in lessons)
Address (Street, Town/City, and Zip Code) *
Best Phone Number for Communication *
Brandeis offers two purchasing options; Full Session and Flex Dates. If you are planning to attend all swim lessons this spring, select Full Session. If you know certain dates conflict with your schedule, select Flex Dates and indicate which dates your child(ren) will attend.
Please Choose Frequency of Lessons *
If choosing Flex Dates, please select the sessions you are able to attend (If purchasing Full Session select N/A) *
Required
Please Choose Preferred Class Time *
Required
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If you are an adult interested in lessons, just write N/A for the "child name" questions below. Thanks!
Child #1 (Name and Age) *
Instructor Preference
Previous Lesson Experience? *
Please describe level or experience *
Child #2 (Name and Age)
Instructor Preference
Previous Lesson Experience?
Clear selection
Please describe swim level or experience
Child #3 (Name and Age)
Instructor Preference
Child #4 (Name and Age)
Instructor Preference
Previous Lesson Experience?
Clear selection
Please describe level or experience?
Child #5 (Name and Age)
Instructor Preference
Previous Lesson Experience?
Clear selection
Please describe level or 
How did you hear about us?
___________________________________________________________
These lessons help fund our Brandeis University Swimming and Diving Team, thank you for signing up! We really appreciate it!
A copy of your responses will be emailed to the address you provided.
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