Have you or your children ever been enrolled in the Personalized Swim Instruction™ program?
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First name
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Spouse's first name [if applicable]
Spouse's last name [if applicable]
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Community [Enter the name of your neighborhood or community.]
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Who will usually be transporting the student(s) to their lessons? Sometimes we need to contact the person who will be bringing the student(s) to class because of last minute changes due to weather, construction, maintenance, pool conditions, etc.
Relationship [eg. Grandmother, Neighbor, etc.]
You may enroll a maximum of five students at a time using this form.(All of our swim classes are limited to a maximum of four students per instructor.)
Student's first name
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Student's date of birth [MM/DD/YYYY]
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Ability Level: Because we are very particular about matching students according to a combination of age and ability, we need to gather specific information about each student's swimming ability.
This student has taken one or more swim classes with Jeff Kelly inc. and I have the "Student Ability Report" from the most recent session. (You will find the "Ability Level" on the backside of that report at the bottom labeled: "Student's Ability is now..." Please enter that number/letter combination here: Ability level
Please determine the student's "Ability Level" by carefully answering the questions detailed in the [Determine Student Ability Level] portion of our website. Please choose the student's "Ability Level": Ability level Choose Ability 1a 2a 2b 2c 3a 3b 3d
Please let us know if you have any special concerns about this student. Notes
Please take a moment to familiarize yourself with the general class times available at our facility. In the next tab, "Sessions", you will be presented with the exact sessions (date ranges) and class times.
Town Village of Leawood: 4400 West 115th Street, Leawood, KS 66211 [map and directions]The swimming pool water temperature is controlled at 90 degrees!
Spring classes are offered during April and May; from 4:15 PM through 9:25 PM. Each class is 35 minutes in duration. A "session" consists of six (6) 35-minute lessons; two lessons per week for three weeks.
Summer classes are offered during June and July; from 4:00 PM through 9:20 PM. Each class is 35 minutes in duration. A "session" consists of six (6) 35-minute lessons; three lessons per week for two weeks.
We will enroll each student in ONLY one of the class times you select from the pick list of times provided for each applicable session. This will make sense to you when you select the [Facility] and then the [Session] in the feature below. As you will see, you will be able to select and rank up to four class-time-options for each student for each session. This will provide us with flexibility in selecting the class times most compatible (with regard to a combination of age and ability), for each student within your specified availability. If we are unable to enroll the student(s) in any of the class-times that you select, we will contact you to discuss the options.
Please call 816-942-7946 or contact us through our website form if you have additional questions.
Each class is 35 minutes in duration. **Classes beginning after 8:00 pm can be scheduled individually or in partial session increments, with the option for 35-minute or 70-minute lessons. Contact us to discuss pricing and availability.
Please contact me about creating a special arrangement for only my children and/or for only my children and friend(s) children (i.e. a “Private” class or an “Exclusive Group” class of only two or three students, etc.). (Note: All of our classes are limited to a maximum of four students.)
Student #1:
Please provide your payment information via this secure payment form.
Your credit card will only be charged for the sessions in which we are able to enroll the student(s). We will contact you to work out alternative times if we are unable to enroll you in your desired session(s).
I understand and I agree to the "Enrollment Procedure and Policies" and the "Rescheduling Policies for Weather & Pool Maintenance". I further understand that once I am enrolled, my payment is non-refundable unless Jeff Kelly inc. cancels the session(s). [Click here for our full policies.]
I understand that my enrollment is not final until I have received a confirmation via email and/or telephone from Jeff Kelly inc.
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Expiration date Month 01-January 02-February 03-March 04-April 05-May 06-June 07-July 08-August 09-September 10-October 11-November 12-December Year 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035
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Everything in the form was filled out correctly if all the steps have a green checkmark icon. A red X icon indicates that some information is missing or contains invalid data. Please review and correct the errors prior to submitting your registration.
Your enrollment is not final until you have received a confirmation via email and/or telephone from Jeff Kelly inc. that you have been successfully enrolled in your desired session(s).
We will contact you at our first opportunity. However, if you don't hear from us within three (3) business days, please call us at 816-942-SWIM(7946).
If you wish to review or edit your information, simply click on the applicable tab(s) above.
Submit Enrollment
Student #2:
