Private Swim Lesson Payments – Atholton Swim Club

Please complete the form below to pay for your Private Swim Lessons.

Name(Required)

First Last

Email(Required)

Phone(Required)

Name of Person(s) Receiving Private Lesson(Required)

First Last

Name of Instructor(Required)

List Dates and Times of Lessons You Are Paying For:(Required)

Quantity(Required)

Please add up the total number of hours. If not a whole number, please indicate .25 for 15 minutes, .33 for 20 minutes, and .50 for 30 minutes.

Hourly Rate(Required)

Subtotal

$0.00

Online Processing Fee

2.9% plus $0.30 per transaction

Price: $0.00

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name