New Customer QuestionnaireAnswer these quick questions to see the best classes for you!Number of Students*One StudentsTwo StudentsThree StudentsFour StudentsLocation*I am looking for classes in...Spotsylvania - Saint Michael High SchoolStafford - Jeff Rouse Swim and Sport CenterFredericksburg - Central ParkStudent's Name (1)*Classes for...*I'm looking for classes for...My childAn adultSpecial needsPrivate 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 LessonGroup ClassAge of Child*How old is your child?Six months to three years oldThree to five years oldSix years old or olderSkill 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. (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. (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 childAn adultSpecial needsPrivate 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 LessonGroup ClassAge of Child (2)*How old is your child?Six months to three years oldThree to five years oldSix years old or olderSkill 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. (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. (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 childAn adultSpecial needsPrivate 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 LessonGroup ClassAge of Child (3)*How old is your child?Six months to three years oldThree to five years oldSix years old or olderSkill 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. (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. (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 childAn adultSpecial needsPrivate 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 LessonGroup ClassAge of Child (4)*How old is your child?Six months to three years oldThree to five years oldSix years old or olderSkill 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. (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. (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!Name*Phone*Email*
