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 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 Name
Last 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 1
Level 2
Level 3
Level 4
Level 5
Swim Club
Never 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:
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Weekends
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 Name
Last Name
Phone Number
*
Please enter a valid phone number.
E-mail
*
example@example.com
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