2025-2026 Private Swim Interest Form

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Thank you for your interest in Private Swim Lessons with us at the J! This form is designed to collect necessary information in order to pair you with an instructor. If you have any questions, please call the aquatics office at (913)327-8012 or (913)327-8022.

Parent/Guardian: First and Last Name *

Participant(s): First and Last Name *

Contact Phone Number: *

Contact Email: *

Participant(s) Date of Birth: *

Are you currently a Member of the J? *

Yes

What types of sessions are you interested in? Check all that apply. Shared lessons might get paired quicker. *

Private: (1:1 with an instructor)

Semi: (2 participants, 1 instructor)

Shared: (3-6 participants of similar age/skill, 1 instructor)

Required

What is your availability? Check all that apply *

Morning (9am-12pm)

Afternoon (12pm-4pm)

Evening (4pm-8pm)

Unavailable

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are the Swimmers in the CDC? We are able to bring them to and from the CDC for lessons during the day if needed. *

Yes

Instructor Preference: *

Male

Female

Either

Current Swim Level: *

Beginner (can't blow bubbles/submerge, possible discomfort or fear in the water)

Intermediate (has some swim abilities, needs to refine technique)

Advanced (stroke refinement and swim team/fitness swimming prep)

Unknown (call to schedule an assessment)

Goals you'd like to share with us/instructor: *

Specific Instructor Requests: (if you have a name of someone you'd prefer to work with)

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