Concierge If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name * Last Name * Email * Phone * Hotel Name * Hotel Address Parking Instructions * Valet Available * YesNo Parking Cost Per Visit * Concierge Agent's Name * Preferred Form Of Payment For Commission Check Paypal Concierge Agent's Paypal email address Number of Desired Lessons * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Length of Lesson * 30 minutes 1 hr 2 hrs Number of Students 1 2 3 4 Student's Name * Student's Age * 6-18 months 18-24 months 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-30 31-60 61+ If registering more than one student include their names & ages here Swimming Ability * Complete Beginner Complete Beginner Fearful of Water Beginner Prior Lessons Intermediate Advanced Questions or things we should know about the student? (special needs, medical issues, goals) Desired Lessons Per Week * 1 Lesson2 Lessons3 Lessons4 Lessons5 Lessons6 Lessons7 Lessons Desired Start Date Days Available (check as many as possible) * MondayTuesdayWednesdayThursdayFridaySaturdaySunday Times of Day Available (check all that apply) * Early Morning 6-8amMorning 8am-12pmAfternoon 12-3pmLate Afternoon 3-6pmEvening 6-8pm Special Scheduling Requests * I have read and agree to the Liability Release, Assumption of Risk, and Policies. Click here to read* * Yes The Swim Lessons Agreement is an electronic contract that governs your use of and access to the Wiki Wiki Swim School LLCÂ website and services. Upon agreeing to the Swim Lessons Agreement when completing the swim lessons registration form, you acknowledge that you understand and agree to be legally bound by the Swim Lessons Agreement and the terms, conditions and notices contained or referenced herein. Checking the box creates an electronic signature that has the same legal force and effect as a handwritten signature. Electronic Signature *
