• Swim and Learn  Swimming Lesson in Orange Park
  • Swimming Lessons with Coach Sally in Orange Park FL
  • Orange Park Swimming Lessons with Coach Sally at Swim and Leanr
Swim and Learn Registration Form
Date
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Parent(Guardian) FULL Name (*)
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Email Address (*)
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Contact Phone (*)
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Cell Phone (*)
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Address (*)
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City (*)
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State (*)
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ZIP Code (*)
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Please fill out the information below for each child.
1) Refer to the Skill Level page to help you decide. 2) Refer to the REGISTRATION INFORMATION page for available dates and times. Please input week in. (example: May 5-9) Every effort will be made to give you the 1st preference choice, but we can not guarantee your request.
Student 1 Name (*)
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Student 1 Age (*)
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Student 1 Gender (*)
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Student 1 Skill Level (*)
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First Date Choice (mm/dd)
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Time Slot
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Second Date Choice
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Time Slot
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Third Date Choice
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Time Slot
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Are you requesting multiple sessions for this student?
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Student 2 Name
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Student 2 Age
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Student 2 Gender
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Student 2 Skill Level
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First Date Choice
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Time Slot
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Second Date Choice
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Time Slot
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Third Date Choice
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Time Slot
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Are you requesting multiple sessions for this student?
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Student 3 Name
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Student 3 Age
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Student 3 Gender
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Student 3 Skill Level
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First Date Choice
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Time Slot
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Second Date Choice
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Time Slot
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Third Date Choice
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Time Slot
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Are you requesting multiple sessions for this student?
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Are you interested in being added to a generic WAITING LIST for notification of any cancellations of appropriate classes earlier than the one you are scheduled for?
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Coach Sally finds it very helpful to be aware of barriers students face to swimming to be able to adapt the lesson plan accordingly. Please describe any issues the student may have that will impact learning. (Ex: fear, physical, learning, emotional)
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Comments:
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