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Private Swim Lesson Request Form
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Please enable JavaScript in your browser to complete this form.
Private Lesson Rates
*
Member: 4 Credits $160
Member: 1 Credit $48
Non-Member: 4 Credits $210
Non-Member: 1 Credit $65
**4 Credits: Four half hour sessions. 1 Credit: One half hour session
Contact Name
*
First
Last
Contact Phone Number
*
Contact Email
*
Emergency Contact
*
Name
Emergency Contact Phone Number
*
Would you like to work with a specific swim instructor?
Jenny Nicoll
Dorothy VanDeCarr
Barbara Lamay
Lesley Ham
What day(s) of the week do you prefer for the lesson(s)?
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time of day would you like to take your lesson?
*
Early morning
Morning
Afternoon
Evening
Participant Information
*
First
Last
Participant Age
*
Ability
*
Beginner
Intermediate
Advance
Is there any specific skill you'd like the swim instructor to focus on?
WAIVER:
*
I acknowledge that I have read this form in its entirety or it has been read to me, and I understand my responsibility in this private swim lesson program in which I will be engaged. I accept the risks, rules, and regulations set forth. Knowing these, and having had an opportunity to ask questions that have been answered to my satisfaction, I wish to participate in this private swim lesson program.
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:
*
First
Last
Submit
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Program Listing
Work at the Y
About Us
Who We Are
Investing in Our Community
Areas of Impact
Board and Volunteer
Contact Us
Community Resources
Membership
Become a Y Member
Welcome to the Y
Online Reservation System
Schedule A Tour
Benefits and Guidelines
Child Watch & Teen Center
Nationwide Membership
Financial Assistance
Browse Programs
Program Guide
Virtual/Reservations
Youth Programs
Swim Lessons
Adult Programs
YMCA School-Age Child Care
Healthy Living Initiatives
Healthy Living Overview
Prescribe the Y
LIVESTRONG at the YMCA
Enhance Fitness
Parkinson’s Programming
Our Wellness Areas
Wellness Center Overview
Personal Training at the Y
Meet Our Trainers
Schedules
Group Exercise Schedule
Pool Schedules
Aqua Fitness Schedule
Gymnasium Schedule
Airnasium Schedule
Summer Camp
Camp Norwich
Camp Prospect
Camp Koala
Be a Y Camp Counselor This Summer!
Give
Donate
Our Corporate Supporters
Capital Campaign
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