Private Lesson Intake Form

Customers Name
First Last
Swimmers Name
First Last
Swimmers Age
Is this your son or daughters first time taking lessons with Premier?*
What skills can your son or daughter already do in the pool?
What are your goals for your son or daughters lessons?
Are you planning on participating seasonally or year round?
Would your prefer a male or female instructor?
Is there anything else you think we should know about your child prior to us starting lessons with them?
Staff Member Completing Form*
CAPTCHA

You have selected a "Blended Learning" course.

2-410 hours online

1.525.5 hours classroom

IMPORTANT: You will not be able to participate in the classroom portion of the class without a completed certificate from the online portion. Failure to complete the online portion will mean you will need to pay for the course again.

Choose different class

I understand

While this may reduce your time in a classroom it also requires you to do the following prior to attending the in-person portion of your training:

Complete online blended learning course through the American Red Cross
Obtain an online completion certificate and bring it to the in-person skills portion of the class

Private Lesson Intake Form

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