Marketing Request Form

PRIVATE SWIM LESSON REQUEST

Please note: This is a general inquiry, not a registration form. Once your form is submitted, our aquatics coordinator will coordinate the 4 sessions with your preferred times with a swim lesson instructor. Once an instructor is confirmed, we will reach out to you to inform you of the times and to take payment for the lessons.
Name of Swimmer:*

First NameLast Name
Age of Swimmer:*
Please select the type of Private Lesson:*

Adult (18+)Youth (3-12)Teen (13-17)
If the swimmer has participated in YMCA Swim Lessons, please indicate the level that the swimmer last participated in.*

Level 1Level 2Level 3Level 4Level 5Swim ClubNever Participated
Please select the swimmers level:*

True Beginner (no previous swim lesson experience)Fearful Beginner (has a fear of the water)Intermediate (comfortable putting face in water and some independent swimming)Intermediate Advanced (knows a few strokes, can swim but needs form work and endurance)Advanced (knows most of the strokes, needs technique and endurance)Other
Preferred days of the week:

MondaysTuesdaysWednesdaysThursdaysFridaysWeekends
Preferred time of day:*

Morning (7am-10am)Midday (10am-1pm)Afternoon (1pm-4pm)Early Evening (4pm-6pm)Evening (6pm-8pm)
What are your goals for the private lesson?:*
Name of requester:*

First NameLast Name
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Scheduling & Cancellation:
At the time of inquiry, participants must schedule 4 sessions. These sessions are booked based on the instructor’s availability and commitment. Once scheduled, sessions cannot be changed or cancelled except in cases of sickness or emergency.

Cancellations Due to Sickness:
If a session is canceled due to sickness, we will do our best to reschedule within the instructor’s schedule, but this is not guaranteed.

No-Show Policy:
If a participant fails to show up for a scheduled session without prior notification, the session will be forfeited and the participant will be charged for the session.

Expiration:
All private swim lessons expire 1 year from the date of purchase. After this period, any unused sessions will be forfeited, and no refunds will be issued.

Non-Transferable:
Lessons are non-transferable and cannot be shared or transferred to another individual under any circumstances.
I understand the scheduling, cancellation and expiration policies:

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PRIVATE SWIM LESSON REQUEST