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Swimming Lesson Registration

 
Please use this form only to register for swimming lessons. I recommend that you visit and observe lessons prior to registration.
 
A ONE TIME registration fee of $45 is payable to Geoff Dawson. Please bring a check to first day of lessons.
 
A separate annual medical release form is required before lessons start. (Available poolside)

If I am too far away I’ll be pleased to refer a closer instructor.

* required
Swimmer Name *
Date of Birth *
Gender
Address
City
State
Zip Code
Mom"s Name
Dad"s Name
Home Phone *
Cell Phone
Email *
How did you hear about The Pool Safety Resource?
Aquatic Experience *
What type of lessons?
Preferred Time of Day

(I will do all I can to accommodate special requests where possible.)




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