Private lessons form - Valleycrest Pool

Piscines Pierrefonds-Roxboro

Private lessons request form

Name of the person in charge(Required)

Email(Required)

Phone(Required)

Name of the person taking the private lesson(Required)

Age of the person taking the private lesson(Required)

Last swimming level achieved(Required)

Preferred time for lessons (more than one answer possible)(Required)

Week days

Weekend

AM

PM

Desired duration for lessons(Required)

30 minutes per lesson

45 minutes per lesson

60 minutes per lesson

Desired number of lessons(Required)

Only 1 private lesson

2 private lessons

3 private lessons

4 private lessons

5 private lessons

Preferred instructor (if any)

Other information

Phone

This field is for validation purposes and should be left unchanged.

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