Midwest Survival Swim Initial Questionnaire

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Midwest Survival Swim Initial Questionnaire

Please fill out this form first to receive a follow up PHONE CALL OR TEXT providing information on how to proceed with scheduling!

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* Indicates required question

Parent's first and last name *

Your answer

Child's (or children's) first and last name *

Your answer

Child/children's date of birth *

Your answer

Parent phone number *

Your answer

Parent email *

Your answer

What type of classes are you interest in?

Survival Swim Lessons

Parent-Tot Class

Time of day you're looking for classes?

Your answer

How did you hear about Midwest Survival Swim? *

Your answer

Any other specific questions?

Your answer

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