Fall Private Swim Lesson Request
Rye YMCA Membership required.
Student Name
*
First Name
Last Name
Student date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/guardian Name (If 18+ please enter n/a)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Availability (Choose all that may work for you. We do not offer private swim lessons outside of the times offered below.)
*
Sunday 9:30-11, 12:30-5:00
Monday 3:00-6:00
Wednesday 6-6:30
Friday 12-3:00
Saturday 2:15-5:15
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
*
Membership Status Confirmation
*
I confirm I have an active membership required for registration
Please check your email for a message from gmoreno@ryeymca.org. You will be contacted once we have found you a match. Thank you for your interest in our private lesson program!
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