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 18+ please enter n/a)*

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

Area CodePhone Number
Availability (Choose all that may work for you. We do not offer private swim lessons outside of the times offered below.)

Monday, 12-5:30Tuesday, 2-3:00Wednesday, 12:15-3:30Thursday, 2:00, 2:30, 2:45Friday, 12-3:00Saturday, 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

MaleFemaleNo 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.
Should be Empty:

Private Swim Lesson Request