Private Lesson Online Sign Up Form

To sign up for private lessons, please complete form and submit. An aquatics staff will contact you within 48 hours to schedule your swim lessons.

I hereby, for myself, my child (if minor), my heirs, executive, waive and release any and all rights and claims for damages I may have against The Summit and its representatives, for any and all injuries suffered myself or my child at any activity sponsored by The Summit.  I understand the risks in the listed activities and state that my health (or child’s health) warrants participation.  I agree to inform instructors of any medical concerns.  I understand photos may be taken during this activity and may be used for promotional materials for The Summit programs.
I have read and understand all private lesson policies and procedures. I understand that if I need to cancel a lesson and do not notify my instructor at least five (5) hours in advance, I will be billed and will promptly pay for the missed lesson. Packages expire twelve (12) months after the date purchased and are non-refundable.

Responsible Party *

Contact email address *

Contact Phone Number *

Type of Lesson:

Student Name 1 for Private Lesson: *

Age Student 1: *

Gender Student 1: *
Male   Female  

Student 1 Swim Ability/Level *

Student Name 2 for Semi Private:

Age Student 2:

Gender Student 2:
Male   Female  

Student 2 Swim Ability Level

Preferred day and time: *

Number of lessons: *
Single   4-Pack   8-pack  

Start date: *

Instructor preference: *
Female   Male   None  

Instructor Preference Name

Important medical information: *

Waiver Signature. By entering your name you agree to the private swim lesson waiver at the top of the page. *