JCC Health Club Private Swim Request Form
Dear Families,

Private swim lessons at the JCC are offered to children and adults starting as young as 6 months old. Please complete this form in its entirety. 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.

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

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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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