Cell Phone Number *

Please provide a cell phone number that we can text regarding your order.

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Name of Swimmer *

Who needs the swimming equipment?

First Name

Last Name

What day(s) is your lesson on? *

Please check all that apply.

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

Sundays

Please check each item you would like below: *

See pictures at the end of this form.

GOGGLES: For children who are intermediate to advanced swimmers who comfortably submerge their face under water (including nose and hairline) for 10 seconds.

MASK: For children who are beginners and do not submerge their face for 10 seconds comfortably with nose and hairline in the water.

FLIPPERS: An excellent investment to teach straight leg kicking and add an extra layer of safety when in the pool. Please tell us your child’s shoe size (flippers should fit snugly).

BELT: An excellent alternative to a lifejacket; they are very comfortable to use in pools when parents are within arms reach. Learning belts are not to be used in boats, etc.