Private Swim Lessons
Parent Name
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Text Message Opt-in (optional)
By checking this box, you agree to receive recurring text messages from the Jewish Community of Louisville to the provided mobile number and also agree to the JCL terms and privacy policy at jcclouisville.org/policy. To subscribe to Trager Family JCC building alerts, text the word ‘START’ to 833-334-0581 and follow the prompts to enroll. Message and data rates may apply.
Contact Email
*
example@example.com
Participant Name
*
First Name
Last Name
Participant Date of Birth
*
-
Month
-
Day
Year
Date
Participant Skill Level (Select One)
*
Beginner
Novice
Advanced
Is the participant fearful of the water/swimming?
*
Yes
No
Is your child enrolled in our ELC?
*
Yes
No
What is your preferred availability?
Ex: Mornings, Evenings, Weekends or specific dates & times.
Do you have any specific goals or other information?
*
Do you have a preferred swim instructor?
Do you have any comments or concerns?
*
Submit
Should be Empty: