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Hampshire Regional YMCA

Private Swim Lesson Request Form

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Private Lesson Rates
**4 Credits: Four half hour sessions. 1 Credit: One half hour session
Contact Name
Name
What day(s) of the week do you prefer for the lesson(s)?
What time of day would you like to take your lesson?
Participant Information
Ability
WAIVER:
1. Payment: All payments must occur at the YMCA Welcome Center desk and a receipt will be given. Direct cash payments will not be accepted by swim instructor. All payments made at the HRYMCA must be used at this location only and cannot be transferred to another YMCA location. 2. Use of Program Records: The information obtained while the participant is enrolled in private swim lesson program will be treated as privileged and confidential. It will not be released to any person without the participants written consent. 3. Choice of Swim Instructor: Private lesson packages purchased at the HRYMCA are not exclusive to a particular instructor. Participants may switch instructors at any time. If the instructor’s employment ceases for any reason, the remaining lessons will be fulfilled by another instructor. 4. Expiration Policy: Private lesson credits may be used for up to one month following the end of the session for which the credit was originally purchased. Missed lessons cannot be accrued, and any lessons not used within the allotted time frame will be forfeited. Exceptions may be extended in the case of medical needs, dependent on physician documentation. Any such documentation must be submitted directly to the Senior Program Director of Wellness & Aquatics at Jennifer.allen@hrymca.org. 5. Rescheduling policy: HRYMCA private swim lesson programs are no different than the structure of any other program within the HRYMCA. A specific date, time, duration, and length, are committed to and agreed upon. Missed lessons will not be rescheduled. 6. Tardiness Policy: If the participant is late by up to 15 minutes, the lesson length will be reduced (i.e. the session will still end at the scheduled time). If the participant is more than 15 minutes late, the lesson will be forfeited. If the instructor is late by up to 10 minutes, the lesson will be extended to maintain the scheduled duration. If the instructor is late by more than 10 minutes, a complimentary lesson may be added to the private lesson program. 7. Refund Policy: Private swim lesson purchases are non-refundable and non-transferable, except in the event that a medical condition prevents the client from continuing swim lessons. A refund for medical reasons must be made in writing and must be accompanied by written documentation from a physician, and will only be granted for unused lessons.
Swimmer/Guardian Name: