Private Swim Lesson Inquiry

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)
7. Private or Semi Private Lesson*

   1. Private
   2. Semi Private (2 people)
9. Age of Swimmer (must be 6 years and older)*
11. Parent's Name*
13. Contact Phone Number*
14. Email Address*
16. Level of Ability of Swimmer*

    1. Beginner
    2. Low
    3. Medium
    4. High
    5. Training
17. Preferred Days & Times*
19. Additional Notes:
Leave This Blank:


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

    This field is not part of the form submission.

23. Submit

* indicates a required field