Private Swim Lesson Request Form

Private Swim Lesson Request Form

YMCA of Greater Dayton
Name of Private Swim Lesson Participant #1*

First NameLast Name
Age of Swim Lesson Participant #1*
Participant #1 Swimming Ability*

No Swimming AbilityBeginnerIntermediateAdvanced
Participant #1 Swim Lesson Background*

First time EVER taking Swimming LessonsFirst Time taking PRIVATE SWIM LessonsRenewing Private Swim LessonsHave participated in Group Swim Lessons in the past
Name of Buddy if registering a second person for a "Buddy Private Swim Lesson"

First NameLast Name
Age of Swim Lesson Participant #2 (Buddy)
Participant #2 (Buddy) Swimming Ability

No Swimming AbilityBeginnerIntermediateAdvanced
Participant #2 (Buddy) Swim Lesson Background

First time EVER taking Swimming LessonsFirst Time taking PRIVATE SWIM LessonsRenewing Private Swim LessonsHave participated in Group Swim Lessons in the past
If participants are under the age of 18 please provide the name of the Parent or Guardian:

Parent's First NameParent's Last Name
Name of Main Contact Person for Scheduling Purposes*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*
Preferred Contact Method

Text MessagePhone CallE-mail
Which Branch are you looking to have Private Swim Lessons at?

Auglaize Mercer - NorthAuglaize Mercer - SouthCamp KernDowntownFairbornHuberKleptzKroger Aquatic CenterPreblePremier Health YMCASouthWest CarrolltonXenia

Please Check All Preferred Days and Time Slots for Private Swim Lessons

Name of Preferred Swim Instructor
Additional information that you would like to share about those participating in YMCA Private Swim Lessons.
NO SHOW POLICY: I accept that it is my responsibility to arrive for the scheduled private lesson at the agreed upon time with the swim instructor. Should I need to change an agreed upon time, I will give at least 12 hours notice. If I give less then 12 hours notice, I will forfeit that private lesson and no make up lesson will be scheduled.*

I understand and agree to the No Show Policy
Next Steps: Your form will be submitted to the Aquatics Director/Coordinator who will contact you to set up the first lesson with your assigned instructor. For the first lesson please bring a copy of your receipt to give to the swim Instructor. After the first lesson, you and the instructor will set up further lessons.
Should be Empty: