Private Swim Lesson Interest Form
Please fill out this form to indicate interest in private swim lessons at the YMCA. If you have any further questions, please contact tbock@ppymca.org.
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Parent/Guardian's first and last name? (if applicable) *
Location Preference *
Phone number? *
Email? *
Participant's first and last name? *
Participant's age? *
Participant's swimming ability?
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Participant's gender? *
Diverse abilities of participant (e.g., ADHD)? *
Reason for requesting private lessons?
Preferred instructor?
What times are you available for lessons? *
Desired package? Each lesson is 30 minutes in length. Please note that FPP is not applicable to private lessons. *
Lessons will be added to the account once scheduled with the instructor.  For the payment: *
I will pay for my private lessons in full before my first scheduled lesson with the instructor.  *
I will bring proof of payment to the first private lesson with my instructor.  *
I must contact my instructor (not the YMCA) at least 24 hours prior to the lesson in order for me to cancel a lesson and not be charged.  *
If I arrive late to my lesson, I understand that my lesson will only last for the remaining time of the scheduled lesson.  *
Please read the following statement. 

Please allow a minimum of two weeks after completion of this form to be assigned an instructor. Once you have been assigned an instructor, they will contact you to schedule your first private lesson. You will be charged once you have scheduled your first lesson with your instructor.  *
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