Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Method of Contact (can select multiple) *

Phone Call

Text

Email

Swimming Ability *

Non-Swimmer (Can't swim and/or fearful of water)

Beginner (Can progress in water but uncomfortable in deep water)

Intermediate (Can progress in water AND comfortable in deep water)

Advanced (Lap swimmer)

Days/Times (can select multiple) *

Preferred times

Mondays - Evening

Tuesdays - Evening

Wednesdays - Evening

Thursdays - Evening

Fridays - Evening

Saturdays - Morning

Saturdays - Afternoon

Sundays - Morning

Sundays - Afternoon

Start Date

If interested in lessons, when are you looking to start?

This month

Next month

Sometime in the future

Enrolled Before?

Has the swimmer been previously enrolled at Bronx Swim?

Yes

No