Levine Jewish Community Center
Lesson Request
Please indicate here your membership status: Active, On-freeze, Cancelled, Non-member
* Required
Primary Contact Information
First Name
*
Parent first name
Last Name
*
Parent last name
Primary Phone Number
*
Phone number
Secondary Phone Number
Email
*
Email
Preferred Contact Method
Primary (Text)
Primary (Call)
Email
Secondary (Text)
Secondary (Call)
Participant Information
First Name
*
First name
Last Name
*
Last name
Gender
*
Sex
M
F
Age
*
Age
Skill Level
*
Skill level
Infant to 3 years
Preschool
K-5
11-17 year old
Adult
Adaptive Swim Lessons
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Preferences
Location
JCC Custodial
Levine Jewish Community Center Aquatics
Levine Jewish Community Center Customer Service
Levine Jewish Community Center Fitness Center
Levine Jewish Community Center Group Fitness
Levine Jewish Community Center MOD/Facility Manager
Levine Jewish Community Center Outdoor Aquatics Entrance
Special Accommodations or Requests
Objectives
General Availability
Please mark the times of the day you are generally available for lessons week to week
AM
AFTN
PM
Morning
Afternoon
Evening
S
Sunday
M
Monday
T
Tuesday
W
Wednesday
R
Thursday
F
Friday
S
Saturday
Packages
Select Available Package
*
Package
Private: ½ Hour-Please purchase your swim vouchers by calling our customer service desk 704-366-5007
Semi Private-15 minute lesson two swimmers sharing a half hour block of time. To purchase your swim vouchers please call our Customer Service Desk at 704-366-5007
ISR-please contact Diana Barnes for additional infomation
[email protected]
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