Swim Lessons at Camp Luz
Instructors provided by the YMCA of Wayne County
Name of Swimmer
*
First Name
Last Name
Age
*
Please Select
3
4
5
6
7
8
9
10
11
12
The swimmer is of the age for Preschool Aged Lessons (3-5)
*
Confirm
The swimmer is of the age for Progressive Aged Lessons (6-12)
*
Confirm
Past swimming experience
Name of Parent/Guardian #1
*
First Name
Last Name
Parent/Guardian #1 Email
*
example@example.com
Parent/Guardian #1 Phone Number
*
Please enter a valid phone number.
Parent/Guardian #2 (optional)
First Name
Last Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
I give permission for my son/daughter to attend swim lessons at Camp Luz. I understand that all water related activities carry inherent risk and agree to hold Camp Luz and the YMCA of Wayne County harmless for any accident or injury to myself or my dependent which may occur as a result of participating in swim lessons.
*
I confirm
Select Session(s)- Swimmers are encouraged to participate in multiple sessions in order to learn and build skills.
*
Session 1- June 10-14
Session 2- June 17-21
Session 3- June 24-28
Session 4- July 8-12
Session 5- July 15-19
Session 6- July 22-26
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Swim Session
Please select the total number of sessions your swimmer will participate in.
$
45.00
Quantity
1
2
3
4
5
6
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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