Primary Guardian Name *

First Name

Last Name

Phone Number *

(###)

###

####

Where will the lessons be held? (**Not your home address**) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What Session(s) would you like to sign up for? *

Red Session (June 3, 4, 5, and 10, 11, 12) — 12:00-3:00pm still available

Orange Session (June 17, 18, 19, and 24, 25, 26) — 12:00-1:30pm still available

Yellow Session — FULLY BOOKED

Green Session — FULLY BOOKED

Blue Session — FULLY BOOKED

Purple Session — FULLY BOOKED

I'd be interested if you added oneeeeee more Session, *possibly* the week of August 25/26/27/28/29

Where did you hear about me? *

Facebook

Instagram

A friend/family member

Client Referral

Google

Let me know who I can thank (if you were referred to by a previous client)!

First Name

Last Name

*

I understand that this form does not secure my dates and times.

I understand that I'm not registered for swimming lessons until full payment is sent to Lauren Park (laurenpark15@hotmail.com)