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Name:


Email:


Phone Number:


Work/Cell Number:


Location (Intersection):


What's the best way to reach you?
(Phone, Email, Time of Day?):

Do you have access to a pool where we can teach you? (if yes, where?):


Are the lessons for you? or a loved one?:


How many times a week would you like to have lessons?:


How old are you or your children?:


How many people would like to learn to swim?:


Lesson Time Preference?:
Mornings
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Evenings
Weekends
Weekdays

What are your swimming goals? Eg. ( Improve overall fitness, to swim comfortably in the water, deep end comfort, improve overall swimming skills and endurance, stronger swimming strokes: front crawl, breast stroke, etc.):




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