Swim Lessons
Registration
Registration Form
Today's
Date
Swim lessons
Grand Hamptons
Bridgewater  (Lakeland)
Package Options:  
Eight 20 minute Lessons for $180 per child
Four  20 minute Lessons for $100 per child   
Please complete the following application. Do not leave any space blank. If a space does
not apply to you please enter N/A. Thank you.
Swim Lessons
Parents Name
Email        example tom@aol.com
Last
 First
Parents Name
Email        example tom@aol.com
Last
 First
Child's Name
 Age
Last
 First
Age
Last
 First
Age
Last
 First
Age
Last
 First
Address
Street
 City
State
Zip
Phone
Work
Home
 Cell
Area Code
 Area Code
 Area Code
Someone other than yourself we can contact in case of emergency.
Emergency
Contact
First
Home
 Last
Area Code
In the box below please give reason for lessons and coaches request if any.
Upon completion of this application a payment is required to register your child.  Please send check or money
order to:               
                                
Make check payable to:    
PROtential Sports
19046 Bruce B Downs Suite 83
Tampa FL 33647

Or pay with Credit Card after submitting information
Please review your answers
and make sure every space
is filled. Then submit.
Beginner Level
Prone floating
Rhythmic Breathing
Back Float
Arm Stroke
Turning over
Safety Skills
Intermediate
Freestyle Stroke
Breast Stroke
Back Stroke
Kicks: Breaststroke, Butterfly
Diving
Flip-turns
Advanced Beginner
Basic Back Stroke
Basic Freestyle
Basic Breast Stroke
Rhythmic Breathing
Diving
(Please fill out the form completely)
For registration information: (813) 843-9460;
Coachjulie@protentialsports.com