JCC Health Club Private Swim Request Form
Dear Families,

Private swim lessons at the JCC are offered to children and adults ages 3 and up. Please complete this form in its entirety. Note that the JCC’s pool is not currently operating at full pre-Covid capacity due to health and safety practices. We appreciate your understanding that we may not be able to guarantee your preferred schedule or instructor at this time, and we will do our best to accommodate you.

At peak times (ex: after school), we have a large demand for limited lesson availability. Your patience is appreciated.The JCC will contact you once we have a potential match for your request or we are happy to talk with you about group lesson options.

We look forward to seeing you at the JCC pool!

JCC Aquatics

Community health and safety remains our top priority, and as such, we’ve strengthened protocols in our building, such as requiring boosters for children’s program instructors, temporarily restoring mask requirements in our Health Club, and a full vaccination requirement for children ages 5 and up.

By February 1, children age 5 and up enrolled in any JCC program in our building must be fully vaccinated.

Parents and caregivers may upload a copy of your child's vaccination proof here: https://docs.google.com/forms/d/e/1FAIpQLScKb5MCW57IWbHUtzZdox45p-ZGiAsavuS_jK2rK4nJEdg40A/viewform

Acceptable proof of vaccination includes a CDC issued vaccination card, the New York State Excelsior Pass, the Clear Health Pass, or the NYC COVID Safe App.

Children turning 5 during the program season will have 60 days following their birthday to become fully vaccinated* and provide proof to the JCC in order to remain in the class.

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Parent / Guardian Name *
Parent / Guardian Email address *
Swimmer's Name *
Swimmer's email address (for mindbody account) *
For ease of booking, we recommend using a separate email address for the chid swimmer. Please note that confirmation emails and receipts will be sent to the parent/guardian email address.
Swimmer's Date of Birth *
Parent / Guardian Street Address *
City *
State *
Zip Code *
Cell Phone Number *
Please Check the Swimmer's Membership Level *
Instructor request notes
Briefly describe the swimmer's aquatic abilities and goals *
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