IF YOU ARE INTERESTED IN ADULT LESSONS, please copy and paste this form to an email, fill it out, and send it to me at wendy4swim@aol.com. Please put "Adult Lessons" in the subject line. 
 

NAME:
 
AGE: 
 
ADDRESS:
 
PHONE:
 
Do You Have Access to a POOL?                 Apartment__________________Home________________Other_________________ 
 
 
MY SWIMMING ABILITY:  (PLEASE ANSWER YES OR NO) 
 
I am a complete beginner_____     I am afraid of the water_____        I am afraid to put my head under water_____          I can float on my front_____  
I can float on my back_____     I can tread water( keep my head above water for one minute) _____     I can go to the bottom of a pool (8 feet)_____  
 
I can exhale underwater (blow bubbles)_____
 
I know the basics of:    Freestyle______     Elementary back stroke______      Breast Stroke_____    Back Crawl Stroke_______      Butterfly_____
 
                                                       Side Stroke __________
 
 
TELL ME A LITTLE BIT ABOUT YOUR FEELINGS AND EXPERIENCE WITH SWIMMING:
 
 
 
 
 
TIMES THAT I AM AVAILABLE FOR LESSONS: Classes are scheduled by appointment and instructor availability
Please specify all days and times that you would be able to schedule a class. 
 
 
 

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