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2. Date of Request*
4. Name of Swimmer:*
6. Recreation Center Member*

   1. Yes
   2. Westlake Resident (if not member)
   3. Non Resident (if not member)
8. Age of Swimmer (must be 5 years and older)*
10. Parent's Name*
12. Contact Phone Number*
13. Email Address*
15. Level of Ability of Swimmer*

    1. Beginner
    2. Low
    3. Medium
    4. High
    5. Training
16. Preferred Days & Times*
18. Additional Notes:
20. Private Swim Lesson Information
    /DocumentCenter/View/14268/Private-Swim-Lesson-Information-PDF

    Click here for additional information on private swim lessons.  

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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field