Participant Name (required)

Participant Birthdate (YYYY-MM-DD)

Gender
MaleFemale

Membership Status
MemberNon-Member

Parent Name (required)

Phone number

Your Email (required)

Swim Ability
ExpertCapableBeginnerNon-swimmer

Preferred Days

Preferred Times

Number of lessons

Instructor Gender Preference
MaleFemaleEither/no preference

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