JCC Health Club Private Swim Request Form
Private Swim Lessons are for children and adults beginning at 12 months. Completing this form in its entirety is imperative to the private swim process. It does not mean lessons have been booked and confirmed. Please understand that JCC private swim lessons are always in high demand and that we will try to schedule your lessons as soon as possible.
Email address *
Date *
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Swimmer's Name *
Your answer
Gender *
Swimmer's Date of Birth *
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DD
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YYYY
Parent/Guardian Name *
Your answer
Parent/Guardian Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code
Your answer
Cell Phone Number *
Your answer
Please Check the Swimmer's Membership Level *
Required
Please Check Instructors Gender Preference *
Required
Briefly define the swimmer's aquatic abilities and goals *
Your answer
Based on the pool schedule available at http://www.jccmanhattan.org/about/hours-schedules/ indicate the days and times that you would prefer private swim instruction. *
Your answer
Please indicate first, second, and third choices including: day, time, and pool.
Submit
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