City of Lafayette
Lesson Request
* 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
Beginner Swimmer
Intermediate Swimmer
Advanced Swimmer
Adult Swimmer
REMOVE PARTICIPANT
ADD PARTICIPANT
Preferences
Location
Rose Lueras Pool @ Bob Burger Recreation
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
3 pack- 30 minute Private Swim Lesson
6 pack - 30 minute Private Swim Lesson
3 pack- 30 minute Semi-Private Swim Lesson
6 pack - 30 minute Semi-Private Swim Lesson
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