Private Swim Lesson Intake Form | Recreational Services | Division of Student Life

First Name

Last Name

Phone Number

Email

Age of Swimmer

Sundays 12 - 4 p.m.

Sundays 4 - 8 p.m.

Mondays 11:30 a.m. - 1:30 p.m.

Mondays 4:30 - 8 p.m.

Tuesdays 11:30 a.m. - 1:30 p.m.

Tuesdays 4:30 - 8 p.m.

Wednesdays 11:30 a.m. - 1:30 p.m.

Wednesdays 4:30 - 8 p.m.

Thursdays 11:30 a.m. - 1:30 p.m.

Thursdays 4:30 - 8 p.m.

Fridays 11:30 a.m. - 1:30 p.m.

Fridays 4:30 - 8 p.m.

Saturdays 12 - 4 p.m.

Please describe your current swimming ability level:

Which swimming strokes can you perform?

How far can you swim without stopping?

Please describe your goals for private swimming lessons? (e.g. what are you trying to achieve)

Is there anything important your instructor should know about you?

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