Julie's Swim School

Email Address: *


Parent's Name: *


Street Address: *


City: *


Home Phone:


Cell Phone: *


Child's Name: *


Child's Age: *
Choose Age 6-12 Months 1-2 Years 2-3 Years 4-5 Years 6-7 Years 8 Years +

Child's Session Level: *
Choose Level Parent-Tot Sunfish 1 Sunfish 2 Sunfish 2+ Adv. Sunfish Turtle 1 Turtle 2 Stroke Class 1 Stroke Class 2 Water Safety

Session Time Preference *
Anytime 9AM-11AM 11AM-1PM 4PM-6PM 6PM-8PM

First Choice Week: *


Second Choice Week: *


Medical Conditions:


Any previous swimming lessons? Please describe:


Additional requests or concerns you or your child may have: