Must Be Registered To Fill Out This Form!Thank you for choosing Survival Swim. Please decide on your package below and follow these steps. How Many Swimmers?*Number of Swimmers?One SwimmerTwo SwimmersThree SwimmerFirst Swimmer's InformationFull Name First Name Last Name Second Swimmer's InformationFull Name First Name Last Name Third Swimmer's InformationFull Name First Name Last Name Scheduling InfoSchedule Confirmation* I have viewed a schedule with an instructor that works with my location and availability. Number of Lessons?*Number of Lessons?Single LessonsSix LessonsTwelve LessonsPrice Per Lesson: $60Price Per Lesson: $83Price Per Lesson: $112Price Per Lesson: $60Price Per Lesson: $55 $5 Discount Per Lesson! Price Per Lesson: $83Price Per Lesson: $75 $8 Discount Per Lesson! Price Per Lesson: $112Price Per Lesson: $107 $5 Discount Per Lesson! Parent's Full Name* First Name Last Name Parent's Phone*Parent's Email* 1 Swimmer - Single Lesson: $60 30 Minute Lesson Already Registered Total: $602 Swimmers - Single Lesson: $108 60 Minute Lesson Already Registered Total: $833 Swimmers - Single Lesson: $153 90 Minute Lesson Already Registered Total: $1121 Swimmer - 6 Lessons ($60 Per Lesson): $360 30 Minute Lessons Already Registered Total: $3601 Swimmer - 12 Lessons ($55 Per Lesson): $660 30 Minute Lessons Already Registered Total: $6602 Swimmers - 6 Lessons ($83 Per Lesson): $498 60 Minute Lessons Already Registered Total: $4982 Swimmers - 12 Lessons ($75 Per Lesson): $900 60 Minute Lessons Already Registered Total: $9003 Swimmers - 6 Lessons ($112 Per Lesson): $672 90 Minute Lessons Already Registered Total: $6723 Swimmers - 12 Lessons ($107 Per Lesson): $1,284 90 Minute Lessons Already Registered Total: $1,284CAPTCHA
