Private Swim Lesson Request
Rye YMCA Membership required.
Student Name
*
First Name
Last Name
Student date of birth
*
-
Month
-
Day
Year
Date
Parent/guardian Name (If swimmer is under 18, if 18 and over, please enter n/a)
*
First Name
Last Name
Email
*
example@example.com
Mobile Phone Number
-
Area Code
Phone Number
Availabililty (choose all that apply)
Monday, 10am-6pm
Tuesday, 11:30am-3:15pm
Tuesday, 6-6:30pm
Wednesday, 12-3:15pm
Wednesday, 6-6:30pm
Thursday, 11:30-3:15pm
Thursday, 6-6:30pm
Friday, 12-3:15pm
Friday, 6-6:30pm
Saturday, 8:30-10:30am
Saturday, 2-3pm
Sunday, 8:30am-3pm
Please note specific times student is available:
Instructor preference
Male
Female
No preference
Name of preferred instructor if applicable
Please describe any special circumstances/needs if applicable
Please describe your past swimming experience and your goals for the lessons.
Please check your email for a response from gloria@ryeymca.org
Submit
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