Marketing Request Form

PRIVATE SWIM LESSON REQUEST

YMCA of Mount Vernon Ohio
Please note: This is a general inquiry, not a registration form. After submitting your request, our Aquatics Coordinator will match your preferred times with instructor availability. Once confirmed, we’ll contact you with the scheduled times and request payment.

Pricing: $120 for members | $160 for non-members

All sessions must be used within 1 year of purchase. Please review our full cancellation and no-show policy before submitting.
Name of Swimmer:*

First NameLast Name
Age of Swimmer:*
YMCA Membership Status*

MemberNon-Member
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.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Scheduling, Cancellation & Pricing Policy*

At the time of inquiry, participants must schedule 4 sessions. These sessions are booked based on instructor availability and commitment. Once scheduled, sessions cannot be changed or cancelled except in cases of sickness or emergency.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.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.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.Lessons are non-transferable and cannot be shared or transferred to another individual under any circumstances.Pricing: Private swim lessons are $120 for YMCA members and $160 for non-members. Payment is required once instructor availability is confirmed.
Liability Waiver & Risk Acknowledgment*

I acknowledge that participation in swim lessons involves inherent risks, including but not limited to slips, falls, and water-related injuries. I agree to release and hold harmless the YMCA of Mount Vernon, its staff, and affiliates from any and all liability arising from participation in private swim lessons. I confirm that the participant is physically able to take part in swim instruction and I will inform YMCA staff of any medical concerns prior to the start of lessons.
I understand the scheduling, cancellation and expiration policies:

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PRIVATE SWIM LESSON REQUEST