Parent's Name *

Phone Number

Address

E-mail

Child or Children's names

Birthday

Ability Level Beginner Intermediate Advanced *

Age Group Under 3 3-5 years old 6-12 years old *

Please Choose a Location Summerlin Centennial Henderson *

How often would you like to come swimming? 1 x per week 2 x per week 3 x per week *

What type of swim lessons are you interested in? Group Private Express Swimming Program Unsure *

Preferred Times 9am-11am 11am-1pm 3pm-5pm after 5pm *