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UAB University Recreation Private Swim Lesson Request Form

Participant/Guardian Contact Information

Last Name:(*)

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Email Address:(*)

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Affiliation:(*)

Member

Non-Member

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First Name:(*)

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Phone [ H W C]:(*)

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Participant Information

Last Name:

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DOB:

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First Name:

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Swimming Ability

Beginner

Intermediate

Advanced

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Second Participant Information

Last Name:

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DOB:

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First Name:

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Swimming Ability:

Beginner

Intermediate

Advanced

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Private Swim Package

Member

4 Lessons $120

8 Lessons $220

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Non-Member

4 Lessons $140

8 Lessons $240

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Partner Swim Package

Price is per person, in order to select this, you must be a 2nd and/or 3rd participant sign up with you (seperate forms is fine, if you do not live in the same household)

Member

4 Lessons $60

8 Lessons $110

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Non-Member

4 Lessons $70

8 Lessons $120

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Preffered Days & Times

Lessons are scheduled in 30-minute increments beginning at the listed time. List preferences in the following format: Saturday 12:00pm, Tuesday/Thursday 7:30pm, meaning that you prefer lessons on Saturdays from noon – 12:30 and Tuesdays/Thursdays from 7:30-8pm. Lessons can be scheduled during the following days & times based on instructor’s availability:

Monday – Friday: 9:00am - 8:00pm
Saturday: 12:00pm - 3:00pm
Sunday: 12:00 pm - 3:00pm

Preferred date to begin lessons (please allow at least 5-7 business days):

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1 st Time Preference:

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2 nd Time Preference:

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3 rd Time Preference:

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Additional Comments

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(*)

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