Kenosha YMCA Private Swimming Lessons

Kenosha YMCA Private Swimming Lessons
Gain confidence in the water and improve your swimming skills with swim instruction tailored to meet your individual goals. Private lessons are available to any age and ability. Let our certified American Red Cross water safety instructors work with you individually or in a small group of your choosing. A variety of options are available, including Private (1 swimmer),Private + 1 (2 swimmers of similar abilities and goals), and Private + 2 (3 swimmers of similar abilities and goals).

All private lessons are 30 minutes in length and can be scheduled at your convenience year round. We do our best to coordinate your preferred days and times while working with our pool and instructor availability.
Today's Date

Month Day Year
Date
Particpant's Name

First Name Last Name
Kenosha YMCA Member

Yes No
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birthdate
Email
example@example.com
Phone Number
Please enter a valid phone number.
Private +1 Participant's Name

First Name Last Name
Kenosha YMCA Member

Yes No
Birthdate
Phone Number
Please enter a valid phone number.
Private +2 Participant's Name

First Name Last Name
Kenosha YMCA Member

Yes No
Birthdate
Phone Number
Please enter a valid phone number.
Type of Lesson:

Private Private +1 Private +2
Is there an instructor you would like to request?

Yes No
If yes, instructor's name:
Have you contacted this instructor?

Yes No
Please list the most recent level of lessons you have completed, as well as any goals you may have for your private lesson.
Sessions Per Week

1 2
Day of the Week Preference (please only list 3):
Time of Day:

8am-10am 10am-12noon 12noon-3pm 3pm-5pm 5pm-8pm
When would you like to start your swimming lessons?
CONSENT TO MEDICAL TREATMENT: As the parent or legal guardian of the above named registrant, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of my dependent.

PHOTO/TALENT RELEASE: I hereby irrevocably release, consent and authorize the Kenosha YMCA and its agents to use my photograph/likeness/voice, as it pertains to my participation with the Kenosha YMCA, in any manner for promotional efforts without expectation of or right to any reimbursement in connection with its use.
Signature (parent/guardian if under 18)

Clear
Should be Empty:

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