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Join PAC
Members
Dolphins Cove
Prairie Pines Golf Club
Programs
All Adult
All Youth
All Programs
Aqua Fitness
Baseball
Basketball
Crossfit
ESP Elite Sports Performance
Group Fitness Classes
Martial Arts
PAC Kids / Summer Camps
Personal Training
Pickleball
Preschool: The Learning Academy
Racquetball
Red Cross
Soccer
SOL Yoga
Swimming
Training Zone
Volleyball
News & Events
PAC Newsletter
PAC Information
Fit Rewards
PAC Employment
Parties & Room Rentals
Facility Rentals
Food & Beverage
Join PAC
Members
Dolphins Cove
Prairie Pines Golf Club
Programs
All Adult
All Youth
All Programs
Aqua Fitness
Baseball
Basketball
Crossfit
ESP Elite Sports Performance
Group Fitness Classes
Martial Arts
PAC Kids / Summer Camps
Personal Training
Pickleball
Preschool: The Learning Academy
Racquetball
Red Cross
Soccer
SOL Yoga
Swimming
Training Zone
Volleyball
News + Events
PAC Newsletter
PAC Information
PAC General Information
Fit Rewards
PAC Employment
Parties & Room Rentals
Facility Rentals
Food & Beverage
PAC Schedules
My Account
Cart
Search
Join PAC
Members
Dolphins Cove
Prairie Pines Golf Club
Programs
All Adult
All Youth
All Programs
Aqua Fitness
Baseball
Basketball
Crossfit
ESP Elite Sports Performance
Group Fitness Classes
Martial Arts
PAC Kids / Summer Camps
Personal Training
Pickleball
Preschool: The Learning Academy
Racquetball
Red Cross
Soccer
SOL Yoga
Swimming
Training Zone
Volleyball
News + Events
PAC Newsletter
PAC Information
PAC General Information
Fit Rewards
PAC Employment
Parties & Room Rentals
Facility Rentals
Food & Beverage
PAC Schedules
My Account
Cart
Search
Private Swim Lesson Interest Form
Swimmer's First Name
*
Swimmer's Last Name
*
Responsible Adult
Adult First Name
*
Adult Last Name
*
Adult Phone
*
Adult Email Address
*
DOB
*
Month
*
Day
*
Year
*
Age of Swimmer
*
18 + yrs old/under 18 yrs old
18+ yrs old
Under 18 yrs old
Contact Information
Swimmer Phone Number
*
Swimmer Email Address
*
Are you interested in Private or Semiprivate lessons?
*
Private/Semi-Private
Private
Semi-Private
For Semiprivate lessons, swimmer will need to supply partner(s) that can attend at the same time and have a similar ability level.
Additional Swimmers
Please list only the names of the additional swimmers in the semi-private group
Additional Swimmer First and Last Name
DOB
*
Month
*
Day
*
Year
*
Preferred Swim Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred Swim Times
Does the Swimmer have any health history that we should know about?
Will a third party be purchasing lessons?
Yes
No
What are the goals for the lesson(s)?
Additional Comments / Questions
Third Party Information
First Name
Last Name
Caseworker Email
*
Submit
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