2. Private Swim Lesson Information
   Thank you for your interest in scheduling private swim lessons with the Litchfield Park Recreation Center! Please note that submitting this form does not guarantee that your private lesson has been scheduled.
4. *Private lessons are subject to instructor availability.
   A Litchfield Park Rec Center Aquatics staff member will be in contact with you within the next 2 - 3 business days. If you need immediate assistance please call 623-935-9040.
8. Name:*
10. Email Address:*
11. Phone Number:*
13. Are you a Litchfield Park resident?*

    1. Yes
    2. No
    3. Not sure
14. Preferred Contact Method:*

    1. Email
    2. Phone Call
    3. Text Message
18. Participant Information
20. Name:*
21. Gender:*

    1. M
    2. F
22. Age:*
24. Identify the swimmer's experience in the water. Check the boxes that apply:
    *

    1. Puts face in the water
    2. Back floats
    3. Front prone float
    4. Back prone float
    5. Flutter kicks
    6. Moves through the water using freestyle arms
    7. Is comfortable in the water
25. Swim Level:*

    1. Infant
    2. Preschool
    3. Beginner
    4. Intermediate
    5. Advanced
    6. Other
27. If you selected other, please give a brief description of the participant's swim background:
31. Preferences & Availability
33. Special Accommodations or Requests:
    Please list any additional information about your lesson needs or request for a specific instructor.
35. Availability:
    Please place a check mark in the boxes to indicate when you are available for private lessons.
37. Day:*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
38. Morning

    1. Yes
    2. Yes
    3. Yes
    4. Yes
    5. Tes
    6. Yes
    7. Yes
39. Afternoon

    1. Yes
    2. Yes
    3. Yes
    4. Yes
    5. Yes
    6. Yes
    7. Yes
40. Night

    1. Yes
    2. Yes
    3. Yes
    4. Yes
    5. Yes
    6. Yes
    7. Yes
42. Private Swim Lesson Packages*

    Please select the private swim lesson time you are interested in. * Semi-private lessons are available with a maximum of 3 students per lesson (price per student shown below). R = Litchfield Park Resident / NR = Non-Resident

    1. 15 minute private ($11R / $13NR)
    2. 30 minute private ($21R / $26NR)
    3. 45 minute private ($32R / $38NR)
    4. 60 minute private ($42R / $51NR)

    1. 30 minute semi-private ($16R / $18NR)
    2. 45 minute semi-private ($24R / $27NR)
    3. 60 minute semi-private ($32R / $36NR)
Leave This Blank:


44. Submit Submit and Print

* indicates a required field