Request Lesson

Fill Out The Form, Then Call Lane: +1.303.818.6232

Remember to print off the FLSL Liability Waiver – 2018 and bring it signed to your first lesson.

Step 1 of 3

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Parent Guardian Info
Primary Contact*
Email*
Cell*
Home*
Secondary Contact
Cell
Preferred Contact Method*
Mailing Address*
Street Address City State ZIP Code

Student Info
Name*
First Last
Age*
DOB*
Date Format: MM slash DD slash YYYY
Gender*
- Male
- Female
Any medications or medical conditions affecting your child’s participation in swimming lessons?*
- No
- Yes
Please explain.*

Lane Martin can be reached by his cell phone at 303-818-6232

Or email lane_martin@msn.com
I understand I need to call or email Lane for my lesson time*
- Yes

Lane +1.303.818.6232