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Private Swim Lesson Intake Form

PLEASE NOTE: Private swim lessons are available for individual students (private) or pairs of students (semi-private) of equal swimming ability. Students must be 3 years of age or older.

Private Lesson Process

Complete and submit this form.
Once the form is received, you will be assigned a private lesson instructor. (Please allow up to a week for this to occur.)
The assigned instructor will contact you to schedule your day and time.
If at any time you have an issue, please contact Stacie, the Recreation Manager, at 208-234-6233.

Parent/Guardian Contact Information

Cell Phone Number

Do you text?

Yes

Student Information

How many students will be receiving the swim lesson(s)?

1 Student | Private

2 Students | Semi-private (must have same swimming ability)

Student Age (3 years and older only)

Student #1 Age (3 years and older only)

Student #2 Age (3 years and older only)

Available Days

Available Times

Swim Level/Ability (please mark approximate swim ability)

Non-Swimmer – No experience, probably hesitant to put face in water

Beginner – Likes water, may put face in but definitely needs support in water

Advanced Beginner – Loves water, puts face in but still needs some support with floats

Intermediate – Comfortable in water, knows basic strokes (front crawl, back crawl)

Advanced – Needs technique and endurance skills but knows their stuff

Is there any degree of fear of the water?

Yes

If yes, please explain or describe.

Are there any physical or mental conditions that would be helpful to be aware of for instructional modifications?

Yes

If yes, please explain or describe.

Any specific swimming goals or particular skills you would like the instructor to focus on?

Any other questions or comments for the instructor?

Private Swim Lesson Intake Form

Parent/Guardian Contact Information

Parent/Guardian Name

Do you text?

Student Information

How many students will be receiving the swim lesson(s)?

Student Name

Student #1 Name

Student #2 Name

Swim Level/Ability (please mark approximate swim ability)

Is there any degree of fear of the water?

Are there any physical or mental conditions that would be helpful to be aware of for instructional modifications?