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 swimmer is under 18, if 18 and over, 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, 3:45-5:15pm
Friday, 3:45-5:15pm
Saturday, 1:30-4pm
Please note specific times student is available if your desired time is not listed above or if you have selected a large time option:
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 and your goals for the lessons.
Please check your email for a message from privateswim@ryeymca.org. You will only be contacted once we have an instructor available who matches your preferences. We appreciate your patience and understanding in the meantime!
Submit
Should be Empty: