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Private Swim Lesson Request Form
We have just a few questions that will help us to match you with the best possible instructor based on your needs! Please put n/a if a question does not apply.
What type of lessons are you interested in?
Adult Lap Swim
Fear of water
Skill Level/Swimming Experience
What are your goals for the lesson?
Type of Request?
Pricing (All 30 minutes)
1 Private Lesson: $20Member / $25Non-Member
1 Private Lesson, 2 Children: $28M/$38NM
1 Private Lesson, 3 children: $33M/$48NM
3 Private Lessons: $55M/$70NM
3 Private Lessons, 2 Children: $78M/$108NM
3 Private Lessons, 3 Children: $90M/$135NM
6 Private Lessons: $100M/$130NM
6 Private Lessons, 2 Children: $144M/$204NM
6 Private Lessons, 3 Children: $162M/$252NM
For Child: Parent/Guardian's First Name(s)
For Child: Parent/Guardian's Last Name(s)
Phone Number (s) (xxx-xxx-xxxx)
Email Address (for the instructor to contact)
Preferred Method of Contact
Any Additional notes or comments that you would like your instructor to know about you or your swimmer?
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This form was created inside of Winona Family YMCA.