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UNC Aquatics
PRIVATE SWIM LESSONS REGISTRATION FORM

UNC Aquatics offers quality aquatic instruction based on the American Red Cross Learn to Swim Program. Classes are
taught by Water Safety Instructors or instructors with similar qualifications. For additional information on these classes,
please click onwww.aquat ics.unc.edu or contact Marty Pomerantz at 962-2779.

Name of Participant:
Age:
Gender:
PID Number:
Name of Parent/Guardian and PID
(if participant is < 18yrs):
Home
Phone:
Work
Phone:
Address:
Cell Phone:
Email:
Emergency Contact (other than above) \u2013 Name:
Phone:
HOW WOULD YOU CLASSIFY YOURSELF:

\ue000 Beginner swimmer with no experience
\ue000 Beginner swimmer with some experience
\ue000 Intermediate swimmer

\ue000 Advanced swimmer
WHAT ARE YOUR SWIMMING GOALS?
HOW MANY TIMES A WEEK DO YOU WISH TO MEET?
PLEASE CHECK THE PACKAGE SELECTED: (All sessions are 45 minutes)
One student (1:1 ratio):\ue000 1 session - $20.00
\ue000 4 sessions - $75.00
\ue000 8 sessions - $140.00
Two students (1:2 ratio)*:\ue000 1 session - $35.00
\ue0004 sessions - $120.00 \ue000 8 sessions - $200.00
* 2 students must be of similar skill level
PLEASE CIRCLE ALL YOUR PREFERRED DAYS & TIMES THAT YOU ARE AVAILABLE:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
6:00 \u20138:00AM 6:00 \u20138:00AM 6:00 \u20138:00AM 6:00 \u20138:00AM 6:00 \u20138:00AM
1:30-2:30 PM
Lunch Swim
Lunch Swim
Lunch Swim
Lunch Swim
Lunch Swim
Noon \u2013 1:00 PM
2:30 \u2013 3:30 PM
4:00 \u2013 5:00PM 4:00 \u2013 5:00PM 4:00 \u2013 5:00PM 4:00 \u2013 5:00PM 4:00 \u2013 5:00PM
1:00 \u2013 2:00 PM
3:30 \u2013 4:30 PM
5:00 \u2013 6:00PM 5:00 \u2013 6:00PM 5:00 \u2013 6:00PM 5:00 \u2013 6:00PM 5:00 \u2013 6:00PM
2:00 \u2013 3:00 PM
4:30 \u2013 5:30 PM
6:00 \u2013 7:00PM 6:00 \u2013 7:00PM 6:00 \u2013 7:00PM 6:00 \u2013 7:00PM 6:00 \u2013 7:00PM
3:00 \u2013 4:00 PM
7:00 - 8:00PM 7:00 - 8:00PM
7:00 - 8:00PM
7:00 - 8:00PM
8:00 - 9:00PM 8:00 - 9:00PM
8:00 - 9:00PM
8:00 - 9:00PM
Please return form and payment (cash or check
made payable to Dept. EXSS) to:
UNC Aquatics Attn: Marty Pomerantz

Campus Recreation, CB# 8610
University of North Carolina
Chapel Hill, NC 27599-8605

Total Amount Paid:______________
Office Use Only:
Schedule:
Instructor:_____________
You will be contacted within 3 business days to schedule the first session.
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