First Name

Last Name

Phone *

Email *

Choose Location(s): Multi-selection *

Abbotsford (April 2025)
Burnaby Lake City
Chilliwack
Como Lake
Coquitlam
Langley [Glen Valley]
Langley [Fraser Hwy]
Central Maple Ridge
East Maple Ridge
Mission
POCO [Hyde Creek]
Richmond (April 2025)
Surrey Panorama Ridge
South Surrey
Whonnock
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Lesson Type *

Private Lessons
Semi Private
Group Classes
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Preferred Day(s): Multi-selection *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Preferred Time *

Morning
Afternoon
Evening
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What level was last completed by the swimmer? *

Preschool 1
Preschool 2
Preschool 3
Preschool 4
Preschool 5
Swimmer 1
Swimmer 2
Swimmer 3
Swimmer 4
Swimmer 5
Swimmer 6
Unknown - will need assessment
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Notes

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