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 Street Address City State ZIP Code

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*

How many students are taking lessons?*

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

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?*

Comments and Concerns

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?*

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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