Private Swim Lesson Request Form

*** STILL UNDER CONSTRUCTION ***
Private Swim Lesson Request Form

All registrants must complete and return this form with payment.
Registrants will be contacted within one week of submitting this form to discuss lesson scheduling.
 STEP 1: REGISTRATION   
Registration Type:   New Registration   Renewal  

Name of Person Requesting Lesson:

 
Lesson Participant(s) Name:
 
Lesson Participant(s) Age:   
Best Phone:
 
Alternate Phone:
 
Email:
 
STEP 2: LESSON PREFERENCES   
Choose which lesson type you prefer: 
     
Instructor Preference:     
Recommended by:     
STEP 3: SCHEDULING PREFERENCES   
Please check your top three choices below.  
                                           
Mondays   4 pm  4:30 pm   5 pm  5:30 pm  6 pm  6:30 pm  7 pm   
Tuesdays   4 pm  6 pm   6:30 pm   7 pm   
Wednesdays  4 pm  4:30 pm  5 pm  5:30 pm  6 pm  6:30 pm  7pm   
Thursdays  4 pm  6 pm  6:30 pm  7 pm   
Saturdays  11:30 am  12 pm  12:30 pm  1 pm   
Sundays  10 am 10:30 am  11 am  11:30 am   
STEP 4: LESSON PARTICIPANT INFORMATION   
Participant 1  
Name:    
Age:    
 Have you done lessons previously?  No   Yes  
 If yes, how long ago?    
 Please check the box below that best describes participant's skill level:   
     Fear of Water
     Comfortable in water but won't put head under yet
     Can swim under water doggie paddle to side, but cannot do strokes yet  
     Can roughly perform basic strokes  
     Can do strokes well but needs refinement  
     Excellent at stroke and endurance
 
 
Participant 2
   
 Name:    
 Age:    
 Have you done lessons previously?  No   Yes  
 If yes, how long ago?    
  Please check the box below that best describes participant's skill level:    
     Fear of Water 
     Comfortable in water but won't put head under yet 
     Can swim under water doggie paddle to side, but cannot do strokes yet  
     Can roughly perform basic strokes  
     Can do strokes well but needs refinement  
     Excellent at stroke and endurance 
 
 
Thank you for completing the request form.  The private lesson coordinator will contact you to schedule your lessons.  If you have any questions, please call THE HEIGHTS at (314) 645-1476 or aquatics@richmondheights.org.   Thank you!
 
     
Comments: