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2. First Name of Contact Person*
3. Last Name of Contact Person*
5. Phone Number*
6. Email Address*
8. 1st Participant First Name*
9. 1st Participant Last Name*
10. 1st Participant Date of Birth*
    1st Participant Date of Birth
12. Available Schedule*

    1. 9:00 am to Noon
    2. Noon to 5 pm
    3. 5:00 - 7:00 pm
    4. Saturday
    5. Sunday
13. Interested Lesson Levels*

    1. Preschool (ages 3-5)
    2. Level 1
    3. Level 2
    4. Level 3
    5. Level 4
    6. Advanced Levels
    7. Lifeguard Preparation
    8. Lifeguard Certification (must be age 15)
15. 2nd Participant First Name
16. 2nd Participant Last Name
17. 2nd Participant Date of Birth
    2nd Participant Date of Birth
19. Available Schedule

    1. 9:00 to Noon
    2. Noon to 5 pm
    3. 5:00 to 7:00 pm
    4. Saturday
    5. Sunday
20. Interested Lesson Levels

    1. Preschool (ages 3-5)
    2. Level 1
    3. Level 2
    4. Level 3
    5. Level 4
    6. Advanced Levels
    7. Lifeguard Preparation
    8. Lifeguard Certification (must be age 15)
22. 3rd Participant First Name
23. 3rd Participant Last Name
24. 3rd Participant Date of Birth
    3rd Participant Date of Birth
26. Available Schedule

    1. 9:00 to Noon
    2. Noon to 5 pm
    3. 5:00 to 7:00 pm
    4. Saturday
    5. Sunday
27. Interested Lesson Levels

    1. Preschool (ages 3-5)
    2. Level 1
    3. Level 2
    4. Level 3
    5. Level 4
    6. Advanced Levels
    7. Lifeguard Preparation
    8. Lifeguard Certification (must be age 15)
29. 4th Participant First Name
30. 4th Participant Last Name
31. 4th Participant Date of Birth
    4th Participant Date of Birth
33. Available Schedule*

    1. 9:00 am to Noon
    2. Noon to 5 pm
    3. 5:00 - 7:00 pm
    4. Saturday
    5. Sunday
34. Interested Lesson Levels

    1. Preschool (age 3-5)
    2. Level 1
    3. Level 2
    4. Level 3
    5. Level 4
    6. Advances Levels
    7. Lifeguard Preparation
    8. Lifeguard Certification (must be age 15)
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35. 1. Receive an email copy of this form.
36. Email address

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37. Submit

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