Conejo Valley Lifeguarding
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Lifeguard Request Form
Swim Lesson Request Form
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Swim Lesson Request Form
Please fill out this form with some basic information regarding your request for swim instruction. We will contact you awith a representative from Conejo Valley Lifeguarding to set up your swim instructor.
*Name:
*Age of Student:
*Skill Level of Student:
-Select a choice-
Beginner
Novice
Advanced
*Address:
*City:
*Phone Number:
Number of Lesons Per Week:
Preferred Days:
Monday
Tuesday
Wednesday
Thrusday
Friday
Saturday
Sunday
Notes: