Private Swim Lesson Instructors JAMIE KNAUFF BIO ANN LASCUOLA BIO JAY MCCASLIN BIO KELLY OSTROWSKI BIO MJ Ziegler BIO Private Swim Lesson Intake Form For Butler YMCA only. Parent/Guardian's First Name Parent/Guardian's Last Name Child's First Name Child's Last Name Date of Birth Address Address Address 2 City/Town ZIP/Postal Code Email Address Phone Number Are you a member of the Butler YMCA - Select -YesNo Have you ever participated in our YMCA group swim lesson program? - Select -YesNo What was the last group swim level your child completed? Briefly explain your ability level in the water (ex: can swim a specific distance with face in or out of water) Do you have any specific needs we should be aware of in order to enhance the quality of your experience? Please indicate your availability. Include day of week and time frame available. Listing several days & time frames will give you the best opportunity to be assigned to an instructor. Please note that Private Lessons WILL NOT be scheduled during our Group Lesson times. NO SHOW POLICY If you do not show up or give your instructor at least 24 hours notice, you will be deducted one of your seven lessons. By signing below, you agree to the NO SHOW POLICY. Signature Sign above Leave this field blank
Private Swim Lesson Intake Form For Butler YMCA only. Parent/Guardian's First Name Parent/Guardian's Last Name Child's First Name Child's Last Name Date of Birth Address Address Address 2 City/Town ZIP/Postal Code Email Address Phone Number Are you a member of the Butler YMCA - Select -YesNo Have you ever participated in our YMCA group swim lesson program? - Select -YesNo What was the last group swim level your child completed? Briefly explain your ability level in the water (ex: can swim a specific distance with face in or out of water) Do you have any specific needs we should be aware of in order to enhance the quality of your experience? Please indicate your availability. Include day of week and time frame available. Listing several days & time frames will give you the best opportunity to be assigned to an instructor. Please note that Private Lessons WILL NOT be scheduled during our Group Lesson times. NO SHOW POLICY If you do not show up or give your instructor at least 24 hours notice, you will be deducted one of your seven lessons. By signing below, you agree to the NO SHOW POLICY. Signature Sign above Leave this field blank
