Interest Form

Please read carefully, and fill out the form below

First name of parent *

Last name of parent *

Email *

Phone *

Do you have a coupon code?

Which location would you prefer to swim at? *

The Puddle (Airport Location - 12029 NE Ainsworth Circle, Portland, OR)

The Pond (Clackamas Location - 16640 SE 82nd Dr, Clackamas, OR 97015)

Either is fine!

Swimmer 1 Name *

Swimmer 1's Date of Birth *

Swimmer 1's pronouns *

In the water, Swimmer 1 is: *

Anxious/Nervous

Enthusiastic/Splashy

Chill/Calm

Is there anything else we should know about Swimmer 1? Please list any relevant experience, diagnosis, disabilities or behavioral information that can help us make sure your child is accommodated appropriately from the first class! *

Swimmer 2's Name

Swimmer 2's Date of Birth

Swimmer 2's pronouns:

In the water, Swimmer 2 is:

Anxious/Nervous

Enthusiastic/Splashy

Chill/Calm

Is there anything else we should know about Swimmer 2? Please list relevant experience, diagnosis, or behavioral information that can help us make sure your child is accommodated appropriately from the first class!

Swimmer 3's Name

Swimmer 3's Date of birth

Swimmer 3's pronouns

In the water, Swimmer 3 is:

Anxious/Nervous

Enthusiastic/Splashy

Chill/Calm

Is there anything else we should know about Swimmer 3? Please list relevant experience, diagnosis, or behavioral information that can help us make sure your child is accommodated appropriately from the first class!

What type of lessons are you interested in? *

Semi-Private (2 students) $260 per swimmer per month

One on One Lessons (1 student) $390 per swimmer per month

Private Pool Lessons (1 student) $600 per swimmer per month (currently on a waitlist)

What times work best for your family? (note - the more flexible you are, the more likely we'll be able to get you in!) *

How did you hear about us? *

Additional info

Promo Code

I agree to terms & conditions provided by the Zen Penguin Swim School. By providing my phone number and email, I agree to receive text messages and emails from the business.

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