Adult Private Swim

Student Name *

Mobile Number: *

Email: *

What type if swimmer are you? *

Lesson Type

What Skills do you want to work on? *

Increase Comfort Level Basic Swimming Techniques Swimming Different Strokes Deep Water Activity

What is your phobia level of the water on a scale of 1-10?

Current Availability Can Be Found Below:

I'm available in January:

Please choose and alternate day and time

*If you are applying to come in on Saturday's in January, we are able to start swim lesson this coming Saturday, January 12th. Lessons will be prorated in the amount of (3) swim lessons.

Once registered, please wait for an email response from us to proceed forward with payment. Please make sure you email address is accurate in form above.

I'm available in February:

Are you taking any medications for seizures, strokes, or diabetes? *

Comments

Have You Already Purchased Lessons?

Our response time is usually within the hour.

Cancelation / Rescheduling Policy:

Photography Policy:

Release & Liability Waiver:

Release of Liability Signature: Signature below will indicate your agreement & complete compliance of All-Star Swim Academy of Atlanta release & liability waiver. Your electronic signature will be equally as binding as an original manual paper signature.

Student Name: *

First Name Last Name

Date of Signature: *

- Day - Month Year

Student Signature: *

We will confirm your day and time via email and once this is done, payment can be submitted.