Review Your Lesson Order


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General
Host Parent Name:
E-mail Address:
Address:
City:
State:
Zip:
Home Phone:
Metro Area:
Swim Instructor:
If payment will be made using a different name or email than left, please list that here:

Name:
E-mail Address:

Total daily lesson time and additional number of lessons
Minutes / Day:
Amount of additional lessons:
Travel Stipend: +$5 travel allowance direct to instructor per lesson due to longer metro travel times
Total Price: $0

Payment details

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