Apply for Swim Lessons Complete three simple steps. Gather your information Fill in the details Submit your application Please enable JavaScript in your browser to complete this form. - Step 1 of 3Applicant DetailsContact informationName *FirstLastEmail address *EmailConfirm EmailPhone numberAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextChild DetailsName and age of children to registerNumber of Children Selected Value: 1 Number of children between 0–6 years oldName *FirstLastAge *NameFirstLastAgeNameFirstLastAgeNameFirstLastAgeNameFirstLastAgeNextEstimated Gross Monthly Income *Household gross monthly incomeAre you receiving government assistance? *YesNoChoose which programs you are currently receiving assistance *SNAP (Food Assistance)AHCCCS (Medical Assistance)Child Care AssistanceCash AssistanceHousing AssistanceRefugee Resettlement AssistancePoof of assistance is required to complete this application. Please upload a copy of your acceptance letter or approved application below. *Swim schools are a collaborative effort between the instructor, the parent and the student to help learn water safety and basic swimming techniques that may save the child's life in the event of a negative water experience. It will require parents to participate in the swim classes along with their infants/toddlers to help build trust and respect for the water and their surroundings.Agreement *I agree with the privacy policy and terms.At JJ's Swim Angels, we value privacy and transparency. In order for JJ's Swim Angels and its partners to process your application, we require your consent. If you consent to receive/continue receiving such information from JJ's Swim Angels and its partners as well as the use of your personal data for such purposes, please click the checkbox above.Signature *Enter your full name as your signatureJJSA Staff ONLYAssigned SchoolAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneSubmit