Request edit access
Private Swim Lesson Request Form
Hello!
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? *
Required
Swimmers Name(s) *
Your answer
Swimmer's Age(s) *
Your answer
Skill Level/Swimming Experience *
Your answer
What are your goals for the lesson?
Your answer
Preferred Instructor
Your answer
Preferred Day(s) *
Required
Preferred Time(s) *
Your answer
Type of Request? *
Pricing (All 30 minutes) *
For Child: Parent/Guardian's First Name(s)
Your answer
For Child: Parent/Guardian's Last Name(s)
Your answer
Phone Number (s) (xxx-xxx-xxxx) *
Your answer
Email Address (for the instructor to contact) *
Your answer
Preferred Method of Contact *
Required
Any Additional notes or comments that you would like your instructor to know about you or your swimmer?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Winona Family YMCA. Report Abuse