Brevard County
321-218-3829
Home
Pricing
Lesson Plans
Meet the Instructor
Register
Pool Requirements
FAQ
Contact
Return Swimmer Registration
Registration Form
Parent(s) First Name
Parent(s) Last Name
Phone Number
Email Address
Address
Pool address hasn't changed
Pool address HAS changed
Pool Address (if it HAS changed)
City
Barefoot Bay
Cape Canaveral
Cocoa
Cocoa Beach
Cocoa West
Grant-Valkaria
Indialantic
Indian Harbor Beach
Malabar
Melbourne
Melbourne Beach
Merritt Island
Palm Bay
Palm Shores
Patrick Air Force Base
Port St. John
Rockledge
Satellite Beac
Sebastian
South Patrick Shores
Suntree
Titusville
Vero Beach
Viera
West Melbourne
State
Option 1
Florida
Zip Code
32780
32781
32783
32796
32901
32902
32903
32904
32905
32906
32907
32908
32909
32910
32911
32919
32920
32922
32923
32924
32925
32926
32927
32931
32932
32934
32935
32936
32937
32940
32949
32950
32951
32952
32953
32954
32955
32956
32958
32960
32963
32964
32876
32978
Number of Students
#1) Student Name
Age
Briefly describe current swimming experience and skill set
# 2 ) Student Name
Age
Briefly describe current swimming experience and skill set
New Field:
Age
Briefly describe current swimming experience and skill set
# 4 ) Student Name
Age
Briefly describe current swimming experience and skill set
# 5 ) Student Name
Age
Briefly describe current swimming experience and skill set
Lesson Type
Private Swim Lessons under 2 years
Private Swim Lessons over 2 years
Group Swim Lessons - 2 or more children of same or similar skill levels
Lesson Package
Single 30-minute lesson (Not available for children under 2 years)
Single 60-minute lesson (Not available for students under 2 years)
Package of 8 lessons
Package of 12 lessons
Package of 16 lessons
Desired number of lessons per week
1 day per week
2 days per week
3 days per week
4 days per week
5 days per week
Preferred Days of the Week
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred WEEKDAY times
Early Morning 8am-10am
Late Morning 10am-12pm
Early Afternoon 12pm-2pm
Late Afternoon 2pm-4pm
Early Evening 4pm-6pm
Late Evening 6pm-8pm
Preferred WEEKEND times
Early Morning 8am-10am
Late Morning 10am-12pm
Early Afternoon 12pm-2pm
Late Afternoon 2pm-4pm
Early Evening 4pm-6pm
Late Evening 6pm-8pm
Preferred Start Date
Would you like to add a charitable donation for Give Kids the World Village?
Ye
No
Unsure
Amount
Comments
Thank you for contacting us.
We will get back to you as soon as possible.
Oops, there was an error sending your message.
Please try again later.
Share by: