Private Swim Lessons

Private Swim Lesson Request

Rye YMCA Membership required.
Student Name*

First NameLast Name
Student date of birth*

MonthDayYear
Date
Parent/guardian Name (If swimmer is under 18, if 18 and over, please enter n/a)*

First NameLast Name
Email*
example@example.com
Mobile Phone Number

Area CodePhone Number
Availabililty (choose all that apply)

Monday, 10am-6pmTuesday, 11:30am-3:15pmTuesday, 6-6:30pmWednesday, 12-3:15pmWednesday, 6-6:30pmThursday, 11:30-3:15pmThursday, 6-6:30pmFriday, 12-3:15pmFriday, 6-6:30pmSaturday, 8:30-10:30amSaturday, 2-3pmSunday, 8:30am-3pm
Please note specific times student is available:
Instructor preference

MaleFemaleNo 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
Should be Empty:

Private Swim Lesson Request