Join Waitlist | Life Aquatics LLC

SUMMER & FALL 2025 WAITLIST INTAKE FORM

Summer is nearly full. You may be contacted if a spot opens

or in May when I open registration for Fall Session 2025.

Parent's Name

Child's Name

Child's Birthday

Month

Day

Year

Email

Phone

Any health concerns since birth (ex: eyes, ears, muscular, allergies)

Multi choice

If "other" please describe

Any developmental delays or behavioral differences since birth?)

Multi choice

If "other" please describe

Any previous swim experience?

Will your child put their head underwater by themselves?

Would you describe your child as..

Can the student's parents swim?

Have you ever experienced water trauma, drowning or near drowning in your family?

Anything else you would like us to know?

By checking this, you are verifying that all the medical information above is accurate, and nothing has been left out. Swimming involves the whole body. I need to know about anything that could affect them in the pool. By leaving out information, you may be unintentionally putting your child in danger by not giving me all the information I need to keep them safe.

By checking this box, you are agreeing to be contacted via text to schedule an intake call to discuss lessons. I am a mother of two young children, small business owner, and I am usually teaching anywhere from 10-30 students to swim at a time. You are busy working parents and caregivers. If we are taking time out of lives to do a call, please have read through my website, and ensure session dates work for your family, as to not waste either of our time.