Swim Assessment Request

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Please correct the field(s) marked in red below:

1

Swim Assessment Request
All fields are required
Child must be at least 3 years old.

Swim Assessment Request All fields are required Child must be at least 3 years old.
2

Contact Methods:

Contact Methods:

---------For Internal Use Only (Please place in Jodi Fisher's mailbox)---------


    
Date _____________________ Day _____________________ Time _____________________


Instructor ____________________________________________________________________


Comments ___________________________________________________________________


Instructor Recommendation______________________________________________________

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