Swim Lesson Registration Form 2023 Swim Lesson Registration Form Parent/ Guardian Name(Required) First Last Date of birth(Required) MM slash DD slash YYYY Participant's Name(Required) First Last Date of birth(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email Address(Required) LESSON TYPESSwim Lesson Options - MEMBER RATES Private Lessons - 1 Member 5, 30 minute lessons $140 Semi Private Lessons - 2 Members, 5, 30 minute lessons $240 Member Group Lessons - 1 Member, 4, 30 minute lessons $110 Member - Swim Team Prep, MWF, 1 month of lessons $110 Member - Junior Sharks, MWF, 1 month of lessons $110 Member FAC Sharks Swim Team - 1 month of practices $70 Swim Lesson Options - GUEST RATES Private Lessons - 1 Guest 5, 30 minute lessons $160 Semi Private Lessons - 2 Guests, 5, 30 minute lessons $260 Guest Group Lessons - 1 Guest, 4, 30 minute lessons $130 Guest - Swim Team Prep, MWF, 1 month of lessons $130 Guest - Junior Sharks, MWF, 1 month of lessons $130 Guest FAC Sharks Swim Team - 1 month of practices $85 CHOOSE YOUR GROUP LESSONS SESSION DATE(S)JUNE 2023 SESSION 5 JUNE 5 - 8, 2023 SESSION 6 JUNE 12 - 15, 2023 SESSION 7 JUNE 19-22, 2023 SESSION 8 JUNE 26 - 29, 2023 JULY 2023 SESSION 9 JULY 3,5,6 & 7, 2023 SESSION 10 JULY 10-13, 2023 SESSION 11 JULY 17 - 20, 2023 SESSION 12 JULY 24 - 27, 2023 AUGUST 2023 SESSION 13 JULY 31 - AUGUST 3, 2023 SESSION 14 AUGUST 7 - 10, 2023 CHOOSE YOUR CLASS LEVEL(S)STARFISH - BEGINNER LEVEL 1For your little one who has little or no experience and who may be hesitant to put his/her face into the water. This course is geared to help students gain confidence through activities. 9:00 AM 10:00 AM 3:00 PM 4:00 PM CLOWNFISH - BEGINNER LEVEL 2For young swimmers who are comfortable in the water and will place their face in without hesitation. This course is focused on water safety skills. 9:00 AM 10:00 AM 3:00 PM 4:00 PM STINGRAY - INTERMEDIATE LEVEL 3Emphasis is placed on survival skills such as floating and gliding. We will introduce front crawl/freestyle and back floating and gliding. 9:30 AM 10:30 AM 3:30 PM 4:30 PM DOLPHIN - INTERMEDIATE LEVEL 4This course places an emphasis on improving swim strokes. Swimmers should be able to swim front crawl and back crawl for the length of the pool. 9:30 AM 10:30 AM 3:30 PM 4:30 PM ADVANCED LEVEL CLASSESThese programs are paid monthly and include all practices, Mon, Wed and Friday, throughout the month. Swimmers are encouraged to attend as many practices as possible. Swim Team Prep is for proficient swimmers who want to prepare to join swim team, or want to increase their stroke technique. Swimmers should be able to swim freestyle & backstroke. Swimmers will learn the basics of butterfly in this course. This is a pre-swim team program for swimmers interested in joining our Sharks Swim Team. Junior team members will focus on improving their stroke technique in freestyle, backstroke, breaststroke & butterfly & also work on competitive skills such as endurance, diving & flip turns. Participants will have 3 practices days per week and may participate in 3-4 swim meets throughout the summer. SWIM TEAM PREP - MON/WED/FRI - 4:30 - 5:15 PM JUNE 2023 JULY 2023 JUNIOR SHARKS - MON/ WED/ FRI - 5:15 - 6:00 PM JUNE 2023 JULY 2023 FAC SHARKSFAC Sharks is a competitive Swim Team. FAC Sharks is paid monthly and includes all practices, Monday - Friday, 6:00- 7:00 PM. We compete in 2-3 meets throughout the summer. FAC SHARKS - MON-FRIDAY - 6:00 - 7:00 PM JUNE 2023 JULY 2023 AUGUST 2023 ADD ON - FAC SHARKS TEAM T-SHIRT - $12 ADD ON - FAC SHARKS SWIM CAP - $8 ADD ON- FAC SHARKS T-SHIRT/SWIM CAP BUNDLE - $15 Select AllPRIVATE LESSON DAY OF WEEK PREFERENCE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY PRIVATE LESSON TIME OF DAY PREFERENCE MORNING AFTERNOON EVENING Credit Card Number Name on Card Expiration date (month/year) CVV Consent I agree to assume full risk and release all claims I and/or the participants may have against the Fayetteville Athletic Club (FAC), including it's agents, servants, and employees, from such claims resulting from injury, damages or loss sustained during participation in any FAC program or event. I understand that I am responsible for all personal medical insurance and the participant's family must cover any cost incurred. I also understand that every precaution is taken to protect the safety of all participants. I agree to any emergency treatment by a physician or hospital in the event that the emergency contact can not be reached.Signature Reset signature Signature locked. Reset to sign again Do you have any additional questions for our Aquatics Director? If everything looks good, please press "Submit" and our Aquatics Director will get back with you shortly. Δ 1 Comment Cassie Nance on May 11, 2023 at 2:45 AM hello! I was interested in the age requirement and cost of your swim lessons!
hello! I was interested in the age requirement and cost of your swim lessons!