Registration Test - InstaSwim

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"*" indicates required fields

Step 1 of 2

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Text Message Opt-In*

Yes - Opt-In To Receive Text Messages. If you don't want to continue receiving SMS please text the word "STOP"

No - I Do Not Wish To Receive Text Messages.

Do you allow us to send you messages regarding the status of your swim lessons, invoicing, and other communications?

Where will lessons take place?*

Pool/Home Street Address City State ZIP Code

If you don't have pool access, please put your HOME street address instead. We may have pool access for you in your area.

Do you have access to a pool?*

Participant's Names*

Participant's Age's*

Start Date*

Does not have to be accurate, please input a rough estimate date/month

Lesson Option*

What is the students main goal?

Have you, a family member, or participants showed any signs or symptoms of covid-19 in the past 10 days?*

Yes

Does participants have any health related issues?*

Yes

If yes, please provide details

Preferred Days/Times?

Instructor Preferences?

If you were referred to us, please list their names

How did you hear about us?

Do you understand that availability is not guaranteed? Please note the more flexible your schedule can be, the easier it will be to match you with an instructor?

Do you understand that InstaSwim will send you an invoice via email after you confirm a start date with your instructor?

Do you understand that there is a one time $20 annual registration fee per student that is added onto your invoice for payment when matched?*

This fee is NOT upfront.

Do you understand and agree to our non-solicitation policy?

Meaning you cannot work any "side deals" with our Instructor or "cut us out" by working directly with our Instructor. We spend a great amount of time and resources to source you the best of the best swim instructors in your area and we kindly ask that you follow this policy.

Comments and Concerns

By submitting your registration, you are agreeing to our 2023 policies & guidelines?

Yes I agree

You can find our policies page located at the bottom of our website.

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