Skip to page body Home Find Books & Do Research My Library Services Programs & Events Kids Teens History Room Support the Library

Library eNews

Survey/Form Review
Private & Semi-Private Swim Lesson Request
Welcome to Mill Valley Aquatics Private & Semi-Private Swim Lesson Request Form.

Please note that questions marked with a * are required.

1. First student's name?
First Name*
Last Name*
2. Second student's name? (applicable to semi-private swim lesson request only)
First Name
Last Name
3. Parent or Student (if Adult lesson request) name?
First Name*
Last Name*
4. First student's age?*

5. Second student's age? (applicable to semi-private swim lesson request only)

6. Contact Phone Number*

7. Email *

8. Has the student taken swim lessons before?
9. What level swim lesson was completed?
10. What are your goals for Private swim lessons?*

11. Desired lesson times - check all that apply.
12. Desired lesson days - check all that apply.
13. How many lessons would you prefer?
14. Number 13 explaination

15. What date can you start?*
Please enter mm/dd/yyyy
16. Describe the student's swim ability

17. Additional information/special requests

18. Instructor Preference