Contact/Company Information:
Important!

To receive payment and do business with the State of Florida you must be registered in MyFlorida MarketPlace (MFMP).

If you are not registered in MFMP, please register before proceeding with Swim Lesson Voucher Instructor registration.


Please ensure your W9 in MFMP is up to date so the department can expedite the payment process.

Complete the following as it is documented in MFMP:

Vendor Name:

Contact Person:

Email:

Confirm Email:

Phone:

Address:

City:

County:

Zip Code:

MFMP Registration Date:


Additional Information
Business name (if different from MFMP):

Website:

Scheduling Contact Name:

Contact Phone:

Contact Email:

Swim Lesson Services:
Evidence based curricula used:


Curricula name:


Note: Any individual or organization that wishes to provide a lifeguard or swimming instructor training and certification course in the state of Florida must use a nationally recognized aquatic training program or equivalent, as defined in 64E-9.008(2)(a)2, F.A.C.


Age Ranges Taught (check all that apply):





If you plan to offer adaptive swim lessons, instructors certification by the Dan Marino Foundation (DMF) must be up to date



Please note: In accordance with Florida Statute, persons providing services to minors (as defined in Section 1.01(13) Florida Statutes) on behalf of the Department are required to pass a Level 1 Background Screening. An attestation must be filed annually to confirm and state the following for all swim instructors performing swim lessons under the Swim Lesson Voucher Program. Electronic signatures are acceptable. Attestation form is provided in the link below. Once completed for each instructor, please submit the supporting documents using the button at the end of the form. If a Level 1 Background Screening has not yet been completed, this can be completed through a local background screening company.