Private Swim Lesson Request

Thank you for choosing the YMCA for Private Swim Lessons. We believe that swimming is a valuable life skill that every child should have access to. Our lessons will help your child develop their skills and build confidence that will serve them through all stages of life.

Private Swim Lesson Location
Lesson Type

Lesson Type Private (1:1) Semi Private (1:2)
Number of Lessons Requesting

Number of Lessons Requesting 1 Lesson 4 Lessons 8 Lessons 12 Lessons
Parent/Guardian Name Parent/Guardian Name First Last
Phone Phone - ### - ### ####
Email
Email Address for Second Family
Participant's Name Participant's Name First Last
Participant's Age

Please answer the following questions about the participant's abilities:
	Yes	No
Will go underwater willingly	Will go underwater willinglyYes	Will go underwater willinglyNo
Can do a front and black float	Can do a front and black floatYes	Can do a front and black floatNo
Can swim 10-15 yards on their front and back	Can swim 10-15 yards on their front and backYes	Can swim 10-15 yards on their front and backNo
Can swim 10-15 yards of both front and back crawl	Can swim 10-15 yards of both front and back crawlYes	Can swim 10-15 yards of both front and back crawlNo
Can swim front crawl, back crawl, and breaststroke across the pool	Can swim front crawl, back crawl, and breaststroke across the poolYes	Can swim front crawl, back crawl, and breaststroke across the poolNo

Preferred Lesson Days
(Days are not guaranteed and are based on Instructor Availability)

Preferred Lesson Days
(Days are not guaranteed and are based on Instructor Availability) Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Preferred Times
(Times are not guaranteed and are based on Instructor Availability )

Preferred Times
(Times are not guaranteed and are based on Instructor Availability ) Morning - 8am to 12pm Mid Day - 12pm to 3pm Afternoon - 3pm to 7pm Other Other

Please indicate your preferred class time: (Northwest YMCA)
	2:00pm	2:35pm	3:10pm
Monday	Monday2:00pm	Monday2:35pm	Monday3:10pm
Tuesday	Tuesday2:00pm	Tuesday2:35pm	Tuesday3:10pm
Wednesday	Wednesday2:00pm	Wednesday2:35pm	Wednesday3:10pm
Thursday	Thursday2:00pm	Thursday2:35pm	Thursday3:10pm


	9:00am	9:35am	10:10am	10:45am	11:20am	11:55am	12:30pm	1:05pm
Friday	Friday9:00am	Friday9:35am	Friday10:10am	Friday10:45am	Friday11:20am	Friday11:55am	Friday12:30pm	Friday1:05pm

1:15pm

Saturday
Saturday1:15pm

	1:15pm
Saturday	Saturday1:15pm


	9:00am	9:35am	10:10am	10:45am	11:20am	11:55am	12:30pm	1:05pm
Sunday	Sunday9:00am	Sunday9:35am	Sunday10:10am	Sunday10:45am	Sunday11:20am	Sunday11:55am	Sunday12:30pm	Sunday1:05pm

Please indicate your preferred class time: (East Valley Family YMCA)
	3:25pm	6:30pm
Monday	Monday3:25pm	Monday6:30pm
Tuesday	Tuesday3:25pm	Tuesday6:30pm
Wednesday	Wednesday3:25pm	Wednesday6:30pm
Thursday	Thursday3:25pm	Thursday6:30pm


	10:00am	11:15am	4:00pm	4:40pm	5:15pm
Friday	Friday10:00am	Friday11:15am	Friday4:00pm	Friday4:40pm	Friday5:15pm

11:25am

Saturday
Saturday11:25am

	11:25am
Saturday	Saturday11:25am


	10:00am	10:40am	11:15am
Sunday	Sunday10:00am	Sunday10:40am	Sunday11:15am

Please indicate your preferred class time: (Palo Alto Family YMCA)
	8:00am	8:40am	9:20am	10:00am	10:40am	11:20am	12:00pm	12:0pm	1:20pm	2:00pm
Saturday	Saturday8:00am	Saturday8:40am	Saturday9:20am	Saturday10:00am	Saturday10:40am	Saturday11:20am	Saturday12:00pm	Saturday12:0pm	Saturday1:20pm	Saturday2:00pm

Comments/Requests:
Membership Status

Membership Status Yes - I am a member No - I am not a member No - I am not a member but am interested in membership to receive the member preferred pricing for Swim Lessons
Please press submit to view all current offerings for the Central YMCA.

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Private Swim Lesson Request

Private Swim Lesson Request

Please press submit to view all current offerings for the Central YMCA.