Please note, completing this form does not complete sign-ups for Private Swim Lessons. A staff member will reach out to you shortly regarding scheduling and registration completion, based on your preference requests. Thank you!Swimmer Name*Swimmer Age*Is Swimmer a current YMCA member?*YesNoSwimmer's Current Status*Fear of WaterCan't swim but is comfortable in the waterBeginnerIntermediateAdvancedDo you know the name of the instructor you want to work with?*NoYesName of Trainer*Contact Name(parent name, if swimmer is a minor)Contact Phone*Contact Email* Select Location*Baxter YMCABenjamin Harrison YMCAFishers YMCAHendricks Regional Health YMCAIrsay Family YMCA at CityWayJordan YMCAOrthoIndy Foundation YMCARansburg YMCAWitham Family YMCAPreferred Days*We will do our best to meet your requirements. The more availability the better; please choose all that apply. Monday Tuesday Wednesday Thursday Friday Preferred Times*We will do our best to meet your requirements. The more availability the better; please choose all that apply. Mornings Lunch Time Afternoons Evenings How did you hear about Private Swim Lessons at the YMCA?*Aquatics StaffBrochureReferred by a FriendFront Desk StaffWebsiteFacebookOther Share Twitter Facebook Email
