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, 12-5:30
Tuesday, 2-3:00, 6:45, 7:15
Thursday, 2:00, 2:30, 2:45
Friday, 12-3:00
Saturday, 2:30-4
Sunday: 2:30-5
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 be contacted once we have found you a match.
Submit
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