Private Swim Lesson Interest
This is not a registration form.
Please provide the information below so we may connect you with one of our certified swim instructors. We will contact you as soon as availability opens! Thank you for your interest in YMCA swim lessons.

1. Due to the high demand for private instruction, we cannot guarantee you an instructor.
2. You must purchase a minimum of 4 lessons and make payment before your first lesson.
3. All students must be members of the West Essex YMCA.
Your Name
Your answer
Phone Number
Your answer
E-mail
Your answer
Name of Swimmer
Your answer
Age of Swimmer
Your answer
(optional) Name of 2nd Swimmer
Your answer
(optional) Age of 2nd Swimmer
Your answer
Tell us your availability (check all that apply)
(morning) 9:00 AM - 12:00 PM
(afternoon) 12:00 PM - 3:00 PM
(after school) 3:00 PM - 6:00 PM
(evening) 4:00 PM - 7:00 PM
(late night) 7:00 PM - 10:00 PM
Monday
Tuesday
Wednesday
Thursday
Friday
SATURDAY
SUNDAY
Does the swimmer have an intellectual or physical disability?
Thank you for choosing the West Essex YMCA!
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