Parent Name *

Student Name *

Phone *

Email *

Location

Fredericksburg (Central Park)
Fredericksburg (Dixon Park)
Spotsylvania (SMHS)
Stafford (JRSSC)
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Lesson Day/Time

Reason for Withdrawal *

Accomplished Goal

Class too easy/hard

Instructor Conflict

Medical

Moving

Other (Please Specify)

Schedule Conflict

Seasonal Enrollment

Unhappy with class

If other, please specify:

Last month my swimmer will attend? *

October
November
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I would like a reminder email to return in:

January
February
March
April
May
June
July
August
September
October
November
December
None
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Please rate your overall experience at Little Fish Swimming *

Excellent
Great
Okay
Poor
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