General
Host Parent Name:
Host Pool Address:
City:
State:
Zip:
Metro Area:
Major Cross Streets: /
Home Phone:
Cell Phone:
E-mail Address:
Children
Days & Times Desired
Lesson Begin Date:
Days:
Hours:
Notes
Known client vacations for instructor awareness:
Parent Notes for Our Office:
Student Special Needs. Current Swimming Level, Fearful, etc:
Lessons
Cost per lesson: $
Registration fee:$20 per child annual registration fee applied.
Lessons:
Total Paid this Lesson Order: $0
