Private Swim Lesson Request

Fall Private Lessons Start the week of September 10th. If you are interested in end of summer privates, please fill out the form below and specify summer in the other comments section.

KCM (Winter 2023–2024) Private Swim Lessons (Page #1)

KCM (Winter 2023–2024) Private Swim Lessons (Page #2)

Participant Name(*)

Please let us know your name.

Participant DOB(*)

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Parent-Guardian Name(*)

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Cell Phone(*)

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Email(*)

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Street Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Are you a Kingsbury Club Member?(*)

Yes No

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Choose one of the following that best describes the participant(*)

Am 3 years old at the start of the program. Can separate from parent and follow instructor directions
Can glide with face underwater 3 yards and is beginning to swim independently using arms, not touching the bottom
Can swim face-in freestyle (crawlstroke) with arms coming out of the water; and swim across the pool without assistance
Can proficiently swim freestyle, backstroke, and breaststroke; and swim 50 yards of both freestyle and backstroke

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Please provide specific earliest and latest lesson starting time for each day you can be at the pool. (For example: Mondays, 8 - 10 AM and 2 - 4 PM)(*)

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Please provide known vacations and other conflicts(*)

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Other Comments (special needs, health concerns, etc.)

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Terms(*)

PLEASE READ TERMS&CONDITIONS HERE

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Private and Semi-Private Swim Lessons

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