New Customer Questionnaire Answer these quick questions to see the best classes for you! Number of Students* One Students Two Students Three Students Four Students Location*I am looking for classes in... Spotsylvania - Saint Michael High School Stafford - Jeff Rouse Swim and Sport Center Fredericksburg - Central Park Fredericksburg - Dixon Park Student's Name (1)* Classes for...*I'm looking for classes for... My child An adult Special needs Private or Group for Children*I prefer the swim lessons be... Private Lesson (1 Child) Group Class (3+ Children) Private or Group Adult Lessons*I prefer the swim lessons be... Private Lesson Group Class Age of Child*How old is your child? Six months to three years old Three to five years old Six years old or older Skill Assessment for 3 to 5 year old*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (M1) Can put their face in the water for 5 seconds. (M2) Can NOT float on their front and back unassisted. (M3) Can float on their front and back unassisted for at least 5 seconds. (M4) Can kick on top of the water unassisted, but cannot swim freestyle. (M5) Can swim freestyle but needs improvement. (M6) Can swim freestyle smoothly. (M7) Can swim backstroke. (M8) Can swim breastroke and butterfly. (S1) Can swim 2 lengths (50 yards) freestyle. (S2) Skill Assessment for 6 plus*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (F1) Can put their face in the water for 5 seconds. (F1) Can NOT float on their front and back unassisted. (F2) Can float on their front and back unassisted for at least 10 seconds (F3) Can kick on top of the water unassisted, but cannot swim freestyle. (F4) Can swim freestyle but needs improvement. (F5) Can swim freestyle smoothly. (F6) Can swim backstroke. (F7) Can swim breastroke and butterfly. (F8) Can swim 2 lengths (50 yards) freestyle. (S1) Skill Assessment for Adult*Please select the option furthest down the list that accurately describes your current skill level. If you are unsure, please underestimate! I am NOT comfortable going underwater yet. (A1) I am comfortable going underwater. (A2) I can float on my stomach and back. (A3) I can kick on top of the water, but I cannot swim freestyle. (A4) I can swim freestyle but I need improvement. (A5) I can swim freestyle VERY smoothly. (A6) I can swim all strokes but would like improvement on technique or endurance. (A7) Student's Name (2)* Classes for... (2)*I'm looking for classes for... My child An adult Special needs Private or Group for Children (2)*I prefer the swim lessons be... Private Lesson (1 Child) Group Class (3+ Children) Private or Group Adult Lessons (2)*I prefer the swim lessons be... Private Lesson Group Class Age of Child (2)*How old is your child? Six months to three years old Three to five years old Six years old or older Skill Assessment for 3 to 5 year old (2)*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (M1) Can put their face in the water for 5 seconds. (M2) Can NOT float on their front and back unassisted. (M3) Can float on their front and back unassisted for at least 5 seconds. (M4) Can kick on top of the water unassisted, but cannot swim freestyle. (M5) Can swim freestyle but needs improvement. (M6) Can swim freestyle smoothly. (M7) Can swim backstroke. (M8) Can swim breastroke and butterfly. (S1) Can swim 2 lengths (50 yards) freestyle. (S2) Skill Assessment for 6 plus (2)*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (F1) Can put their face in the water for 5 seconds. (F1) Can NOT float on their front and back unassisted. (F2) Can float on their front and back unassisted for at least 10 seconds (F3) Can kick on top of the water unassisted, but cannot swim freestyle. (F4) Can swim freestyle but needs improvement. (F5) Can swim freestyle smoothly. (F6) Can swim backstroke. (F7) Can swim breastroke and butterfly. (F8) Can swim 2 lengths (50 yards) freestyle. (S1) Skill Assessment for Adult (2)*Please select the option furthest down the list that accurately describes your current skill level. If you are unsure, please underestimate! I am NOT comfortable going underwater yet. (A1) I am comfortable going underwater. (A2) I can float on my stomach and back. (A3) I can kick on top of the water, but I cannot swim freestyle. (A4) I can swim freestyle but I need improvement. (A5) I can swim freestyle VERY smoothly. (A6) I can swim all strokes but would like improvement on technique or endurance. (A7) Student's Name (3)* Classes for... (3)*I'm looking for classes for... My child An adult Special needs Private or Group for Children (3)*I prefer the swim lessons be... Private Lesson (1 Child) Group Class (3+ Children) Private or Group Adult Lessons (3)*I prefer the swim lessons be... Private Lesson Group Class Age of Child (3)*How old is your child? Six months to three years old Three to five years old Six years old or older Skill Assessment for 3 to 5 year old (3)*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (M1) Can put their face in the water for 5 seconds. (M2) Can NOT float on their front and back unassisted. (M3) Can float on their front and back unassisted for at least 5 seconds. (M4) Can kick on top of the water unassisted, but cannot swim freestyle. (M5) Can swim freestyle but needs improvement. (M6) Can swim freestyle smoothly. (M7) Can swim backstroke. (M8) Can swim breastroke and butterfly. (S1) Can swim 2 lengths (50 yards) freestyle. (S2) Skill Assessment for 6 plus (3)*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (F1) Can put their face in the water for 5 seconds. (F1) Can NOT float on their front and back unassisted. (F2) Can float on their front and back unassisted for at least 10 seconds (F3) Can kick on top of the water unassisted, but cannot swim freestyle. (F4) Can swim freestyle but needs improvement. (F5) Can swim freestyle smoothly. (F6) Can swim backstroke. (F7) Can swim breastroke and butterfly. (F8) Can swim 2 lengths (50 yards) freestyle. (S1) Skill Assessment for Adult (3)*Please select the option furthest down the list that accurately describes your current skill level. If you are unsure, please underestimate! I am NOT comfortable going underwater yet. (A1) I am comfortable going underwater. (A2) I can float on my stomach and back. (A3) I can kick on top of the water, but I cannot swim freestyle. (A4) I can swim freestyle but I need improvement. (A5) I can swim freestyle VERY smoothly. (A6) I can swim all strokes but would like improvement on technique or endurance. (A7) Student's Name (4)* Classes for... (4)*I'm looking for classes for... My child An adult Special needs Private or Group for Children (4)*I prefer the swim lessons be... Private Lesson (1 Child) Group Class (3+ Children) Private or Group Adult Lessons (4)*I prefer the swim lessons be... Private Lesson Group Class Age of Child (4)*How old is your child? Six months to three years old Three to five years old Six years old or older Skill Assessment for 3 to 5 year old (4)*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (M1) Can put their face in the water for 5 seconds. (M2) Can NOT float on their front and back unassisted. (M3) Can float on their front and back unassisted for at least 5 seconds. (M4) Can kick on top of the water unassisted, but cannot swim freestyle. (M5) Can swim freestyle but needs improvement. (M6) Can swim freestyle smoothly. (M7) Can swim backstroke. (M8) Can swim breastroke and butterfly. (S1) Can swim 2 lengths (50 yards) freestyle. (S2) Skill Assessment for 6 plus (4)*Please select the option furthest down the list that accurately describes your child's current skill level. If you are unsure, please underestimate! Can NOT put their face in the water for 5 seconds. (F1) Can put their face in the water for 5 seconds. (F1) Can NOT float on their front and back unassisted. (F2) Can float on their front and back unassisted for at least 10 seconds (F3) Can kick on top of the water unassisted, but cannot swim freestyle. (F4) Can swim freestyle but needs improvement. (F5) Can swim freestyle smoothly. (F6) Can swim backstroke. (F7) Can swim breastroke and butterfly. (F8) Can swim 2 lengths (50 yards) freestyle. (S1) Skill Assessment for Adult (4)*Please select the option furthest down the list that accurately describes your current skill level. If you are unsure, please underestimate! I am NOT comfortable going underwater yet. (A1) I am comfortable going underwater. (A2) I can float on my stomach and back. (A3) I can kick on top of the water, but I cannot swim freestyle. (A4) I can swim freestyle but I need improvement. (A5) I can swim freestyle VERY smoothly. (A6) I can swim all strokes but would like improvement on technique or endurance. (A7) See Your ResultsJust one more step to see which classes we have matched for you! We may use this information to contact you about your lessons or to assist you in finding a class that works for your schedule.First Name* Last Name* Phone*Email* Δ