Swim Lesson Registration

Participant Information

Participant's Name: *

Birth Date: *

Parent/Guardian Information

Parent/Guardian's Name: *

Parent/Guardian's Email: *

Parent/Guardian's Phone/Text: *

*Please note that you will be contacted by text with the instructors contact information.

Skill Level

Please select the level that most closely matches the skill requirements of your child.


Please select preferred day/days and lesson time/times (the following are offered to avoid peak crowds).



Preferred Instructor: *

Cost is $25 per ½ hour session for private and $20 per person per ½ hour session for 2 or more children. Non-member lessons are $35 per ½ hour session and $30 per person per ½ hour session for 2 or more children. Please make checks payable to: Southern Village Club. PAYMENT IS DUE UPON COMPLETION OF EACH LESSON.

Acknowledgement of Waiver and Cancellation Policy

I hereby assume all risks relating to or arising from swimming lessons at Southern Village Club. I release and absolve, Southern Village Club, its managers, owners, agents, employees, volunteers, and sponsors from all liability associated with the activity and in the event of injury, do expressly waive all claims against them.

Southern Village Club maintains a 24 hour cancellation policy. Cancellations made within this time frame or no-shows will be charged the full amount of the lesson. Unexpected illness is understood, but reasonable notice must be provided to avoid being charged.

 * By checking this box and typing my name below, I am electronically signing my application.

Participant/Parent's Signature (Type your name): *

* Required Information

Skill Levels

Level 1: Introduction to Water Skills

  • Learning the pool rules
  • Entering and exiting the pool safely
  • Submerging mouth, nose, eyes underwater
  • Blowing bubbles through their mouth and nose
  • Picking up a submerged toy in shallow water
  • Floating on their back and recovering to feet

Level 2: Fundamental Aquatic Skills

  • Learning the pool rules
  • Swim test requirements
  • Submerging head completely underwater
  • Floating on back and rolling over to front
  • Combining arm and leg motions on front and back

Level 3: Stroke Development

  • Learning the pool rules
  • Swim test requirements
  • Rotary breathing
  • Freestyle and back stroke
  • Butterfly kick and body motion
  • Treading water

Level 4: Stroke Improvement

  • Learning the pool rules
  • Rotary breathing
  • Treading water
  • Freestyle and backstroke refinement
  • Butterfly refinement