YMCA of Bucks and Hunterdon Counties | Private Swim Lessons Intake Form
We are pleased you have selected YMCA of Bucks and Hunterdon Counties for your aquatic needs. Our primary goal is to teach all participants to swim to the best of their ability in a fun, friendly, and safe environment. Please take a few minutes to complete this form with information about the participant so we can ensure we are providing the most appropriate level of support.
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Participant First Name *
Participant Last Name *
Participant Date of Birth *
Primary Phone Number *
Primary Email Address *
Parent/Guardian Name (adult swim participants enter N/A) *
Which branch location would you like to take lessons at? (select any that apply) *
Which swim lesson option are you interested in? *
Please select your preferred days (select any that apply): *
Please indicate your preferred time (We will contact you to schedule an exact time based on your preferences and our current pool schedule): *
Has the participant taken any swim lessons before? If Other, please state where. *
Please select all that the participant is able to do, that you are aware of: *
What is the participant’s goals for these swim lessons? *
Is there anything else you would like us to know?
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