2025 Private Swim Lesson Registration 2025 Private Swim Lessons Private Swim lessons Parent/Guardian Name(Required) First Last Date of Birth of Parent/Guardian(Required) MM slash DD slash YYYY Participant's Name(Required) First Last Date of Birth of Participant(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(Required) Private Swim LessonsPrivate Lessons can be schedule for once a week, twice a week, or four times a week. PRIVATE LESSON RATE MEMBER RATE: $35/lesson, $140/4 lessons GUEST RATE: $40/lesson, $160/4 lessons Lessons are sold in packs of four. MONTH: CHOOSE WHAT MONTH YOU WANT YOUR LESSONS TO BE IN September October November December DAYS OF THE WEEK: CHOOSE ANY DAYS YOU ARE AVAILABLE Sunday Monday Tuesday Wednesday Thursday Saturday What time would you like your lessons at? Morning Evening Notes/Concerns/Ideas/Requests Please indicate any needed accommodations or requests. Credit Card Number(Required) Name On Card(Required) Expiration Date(Required) CVV(Required) Consent(Required) 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.Rescheduling Policy(Required) Lesson Cancellation & Rescheduling Policy Lessons will only be canceled in the event of inclement weather. If your swimmer is unable to attend a scheduled lesson for any reason, written notice is required in advance to be eligible for rescheduling or a lesson credit. To request a reschedule or credit, please email Jana Olson, FAC Aquatics Director, at jolson@fayac.com at least 24 hours prior to the scheduled lesson time.Please note any additional questions, requests, and or concerns for our Aquatics Director. Our Aquatics Director will reach out via email once the registration form has been received.
