Semi-Private Swim Lesson Registration Form (Child)

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Registration Date

Child 1:

Parent Information
   
Parent Name
Home Phone
Alternate Phone
Email
Preferred Method of Contact Home Phone Alternate Phone Email
How many swim lessons would you like to purchase? Single Lesson 5 Pack 10 Pack
Instructor Preference: Male Female No Preference
   
Child Information
   
Child Name
Child Age

What best describes the child's current swim level? Cannot Swim Beginner Intermediate Advanced

Does this child have any fear of the water? YES     NO
Do you have any concerns that you would like noted about this child?


Child 2:

Parent Information
(if the parent information is the same as above, you can leave the parent information blank)
   
Parent Name
Home Address
Home Phone
Alternate Phone
Email
Preferred Method of Contact Home Phone Alternate Phone Email
   
Child Information
   
Child Name
Child Age

What best describes the child's current swim level? Cannot Swim Beginner Intermediate Advanced

Does this child have any fear of the water? YES     NO
Do you have any concerns that you would like noted about this child?


What goals do you hope to achieve with the swim lesson(s)?

What days and times are all of the children available for lessons?

How did you hear about our swim program?

                 

Please stop by the Dedman Center for more information or contact Lindsey Gavlick at 214-768-9916 or lgavlick@smu.edu.

 

 
Recreational Sports is a department in the Division of Student Affairs.