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 18+ please enter n/a)
*
First Name
Last Name
Email
*
example@example.com
Mobile Phone Number
*
-
Area Code
Phone Number
Availability (Choose all that may work for you. We do not offer private swim lessons outside of the times offered below.)
Monday, 12-7:00
Tuesday, 2-3:00, 6:15-7:15
Wednesday, 12:15-3:30, 6-7
Thursday, 2:00-2:45, 6:15-7:15
Friday, 12-3:00
Saturday, 9-5:30
Sunday, 9-5:30
Please note specific times student is available
Please list your top 5 day/time preferences. We will be assigning time slots based on your preferences.
Instructor preference
Male
Female
No preference
Name of preferred instructor if you know
Please describe any special circumstances/needs if applicable
Please describe your past swimming experience
*
Please add your goals for the lessons
*
Please check your email for a message from gmoreno@ryeymca.org. You will only be contacted once we have an instructor available who matches your preferences.
Submit
Should be Empty: