Swim Lessons Payment

Select Program(Required)

Time Slots(Required)

What time slots would you be able to attend? Please select all that would work for you.

12:00-12:30

12:30-1:00

1:00-1:30

1:30-2:00

2:00-2:30

2:30-3:00

Select Swimmer(Required)

Swimmer Age(Required)

Parent Name(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Placement Preference

Would you like your child to be placed with a specific child? (Ex: friend, sibling, etc.) If so, please leave their full name below.

Coach Preference

Connor

Bennet

Either

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Order Token