Private Swim Lesson Request Form

Name of Private Swim Lesson Participant #1

First NameLast Name

Age of Swim Lesson Participant #1

Participant #1 Swimming Ability

Participant #1 Swim Lesson Background

Name of Buddy if registering a second person for a "Buddy Private Swim Lesson"

First NameLast Name

Age of Swim Lesson Participant #2 (Buddy)

Participant #2 (Buddy) Swimming Ability

Participant #2 (Buddy) Swim Lesson Background

If participants are under the age of 18 please provide the name of the Parent or Guardian:

Parent's First NameParent's Last Name

Name of Main Contact Person for Scheduling Purposes

First NameLast Name

Contact Email

example@example.com

Contact Phone Number

Format: (000) 000-0000.

Preferred Contact Method

Which Branch are you looking to have Private Swim Lessons at?

Please Check All Preferred Days and Time Slots for Private Swim Lessons

Rows	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning
Afternoon
Evening

Name of Preferred Swim Instructor

Additional information that you would like to share about those participating in YMCA Private Swim Lessons.

NO SHOW POLICY: I accept that it is my responsibility to arrive for the scheduled private lesson at the agreed upon time with the swim instructor. Should I need to change an agreed upon time, I will give at least 12 hours notice. If I give less then 12 hours notice, I will forfeit that private lesson and no make up lesson will be scheduled.

Next Steps: Your form will be submitted to the Aquatics Director/Coordinator who will contact you to set up the first lesson with your assigned instructor. For the first lesson please bring a copy of your receipt to give to the swim Instructor. After the first lesson, you and the instructor will set up further lessons.