SMALL GROUP PRIVATE SWIM LESSONS & 1:1 PRIVATE SWIM LESSONS Interested in Small Group Private Swim Lessons or 1:1 Private Swim Lessons? Fill out the form below. Have other questions? Please contact us!
Are you a member of the YMCA? Yes No If you would like to register for private swim please check out our membership options! Package Small Group, 8 Lessons 1:1 Private, 4 Lessons 1:1 Private, 8 Lessons Participant Information Please list the participant's first name, last name, and age. If you are looking to enroll in a small group private lesson, please list all names and ages. Participate Name First Name, Last Name & Age Name 2 First Name, Last Name & Age Name 3 First Name, Last Name & Age Name 4 First Name, Last Name & Age Parent/Guardian Information Parent/Guardian Name First Name Last Name Phone Number Email Location - Select -Bay View Family YMCA (Webster)Eastside Family YMCA (Penfield)Maplewood Family YMCA (Rochester)Northwest Family YMCA (Greece)Sands Family YMCA (Canandaigua)Westside Family YMCA (Gates) Is this a continuation of current scheduled lessons? Yes No Who is your current instructor? Do you have a preferred instructor? Please list name What is your current lesson(s) date and time? If no preferred instructor, do you prefer a: Female Male No Preference Desired Start Date: Preferred Availability (please give as much availability as possible to help find a suitable instructor match): What, if any, specific goals do you have for the student? (strength, endurance, balance, motor skill development, comfort in water, safety, basic swimming skills, advanced swimming skills, pass deep end test, vacation): Accommodations and Support Should the swimmer benefit from specialized or differentiated instruction, it is important for us to gather information about methods, tools and other considerations to provide an instructor match and high-quality swim instruction Does the swimmer benefit from any specialized or differentiated instruction? Yes No What is the primary language or method of communication for the student (verbal, pictures, social story, demonstration, gestures, etc): Does the student use any communication devices? Yes No If yes, please specify: Is the student able to independently enter and exit the pool? Yes No If no, what mobility supports does the student need? Are there any concerns related to the pool environment (noise, space, triggers): What does it look like when the student is angry or sad? Are there certain situations, events or types of stimuli that could trigger these feelings? What should staff do when these feelings are triggered? Additional comments or information:
Are you a member of the YMCA? Yes No If you would like to register for private swim please check out our membership options! Package Small Group, 8 Lessons 1:1 Private, 4 Lessons 1:1 Private, 8 Lessons Participant Information Please list the participant's first name, last name, and age. If you are looking to enroll in a small group private lesson, please list all names and ages. Participate Name First Name, Last Name & Age Name 2 First Name, Last Name & Age Name 3 First Name, Last Name & Age Name 4 First Name, Last Name & Age Parent/Guardian Information Parent/Guardian Name First Name Last Name Phone Number Email Location - Select -Bay View Family YMCA (Webster)Eastside Family YMCA (Penfield)Maplewood Family YMCA (Rochester)Northwest Family YMCA (Greece)Sands Family YMCA (Canandaigua)Westside Family YMCA (Gates) Is this a continuation of current scheduled lessons? Yes No Who is your current instructor? Do you have a preferred instructor? Please list name What is your current lesson(s) date and time? If no preferred instructor, do you prefer a: Female Male No Preference Desired Start Date: Preferred Availability (please give as much availability as possible to help find a suitable instructor match): What, if any, specific goals do you have for the student? (strength, endurance, balance, motor skill development, comfort in water, safety, basic swimming skills, advanced swimming skills, pass deep end test, vacation): Accommodations and Support Should the swimmer benefit from specialized or differentiated instruction, it is important for us to gather information about methods, tools and other considerations to provide an instructor match and high-quality swim instruction Does the swimmer benefit from any specialized or differentiated instruction? Yes No What is the primary language or method of communication for the student (verbal, pictures, social story, demonstration, gestures, etc): Does the student use any communication devices? Yes No If yes, please specify: Is the student able to independently enter and exit the pool? Yes No If no, what mobility supports does the student need? Are there any concerns related to the pool environment (noise, space, triggers): What does it look like when the student is angry or sad? Are there certain situations, events or types of stimuli that could trigger these feelings? What should staff do when these feelings are triggered? Additional comments or information: