Request for Individual Swimming Lessons

Name of Student *

First Name Last Name

Date of Birth *

Date

Age *

Parent or Guardian Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Please enter a valid phone number.

Student's Skill Level/Past Swim Experience/Last Level Passed *

Student's Needs/Fears/Goals *

Accommodations:

Days available? *

MONDAY TUESDAY WEDNESDAY THURSDAY

Times available (select all that apply) *

3:55-4:25pm 4:30-5:00pm 5:05-5:35pm 5:40-6:10pm 6:15-6:45pm 6:50-7:20pm Other

Instructor preference:

How comfortable is the student in the water *

Afraid of water Somewhat comfortable Comfortable Extremely comfortable

Will student put their head under water? *

Can student float on their back? (with support or without support from another person)? *

BCC Member *

Aquatic Director or assigned individual will contact the family to schedule a total of 4-30 minute time slots. Payment must be made once Individual Swim Lesson dates have been confirmed. You may call the BCC to pay, with a credit/debit card or BCC Staff will contact you to arrange payment, and to confirm registration.

INDIVIDUAL LESSON POLICY CONTRACT

Individual Lesson Registration Procedures:

1. Parent/Guardian must complete a Request for Individual Lesson form for their child. Each additional child needs to have their own registration form completed.

2. Parent/Guardian must read each policy point and sign below that they have read and understand policies.

3. Aquatic Director or assigned individual will contact the family to schedule a total of 4 30-minute time slots.

Payment Policy:
Payment is required at confirmation of Individual Lesson dates. We accept VISA, MasterCard, Discover and American Express, Cash, or Check.

Inclement Weather Policy:
For the safety of all instructors and participants the community center will cancel group and individual swimming lessons if Becker schools close due to the weather. This will be announced on the Becker Community Center Facebook page. Please call the BCC prior to your class time if you have any questions. The BCC will do their best to reschedule any cancelled classes due to the weather or other unforeseen incidences, if we are unable to reschedule a refund for that class amount will be provided.

Cancellation Policy:

Cancellation requests made within at least two (2) weeks/fourteen (14) days of program start date = full refund.

· Cancellation requests made within one (1) week/seven (7) days of class start = 50% refund.

· Cancellation requests made less than one (1) week/seven (7) days of program start date = no refund given.

Missed Individual Lesson Policy:

There are no make ups offered for Individual Lessons that were cancelled or missed with less than one (1) week/ seven (7) day notice. Individual Lessons that need to be rescheduled by parent/ guardian must be communicated one (1) week/ seven (7) days in advance to the Aquatic Director at ekeenan@ci.becker.mn.us or 763-200-4274. The BCC will do their best to reschedule any lessons with notice. If we are unable to reschedule, a refund for that class amount will be provided (please review cancellation policy to see those refund rates).

Parent/Guardian Printed Name *

First Name Last Name

Parent/Guardian Signature *

Clear

Date *

Date