Request Private Swimming Lessons - Scottsbluff Family YMCA

Private Swimming Lessons

The Scottsbluff Family YMCA currently offers private swimming lessons by request. Lessons will operate on a first-come, first-served basis. Once a request form has been received, an instructor will contact you to set up days/times for the swim lessons. If lessons are full, the Aquatics Coordinator will keep your request form on file and contact you when times become available.

Private Swimming Lessons Request Form

THIS IS ONLY A REQUEST FORM. Payment for lessons will not be taken until after times have been set up with an instructor.

Swimmer's Name

Age

Date of Birth

Gender

Parent / Guardian Name

Date of Birth

Gender

Phone

Address

Emergency Contact Name

Phone

Waiver Acceptance

I understand and am aware that my child will/may be participating in physical activities and that the potential for accidents does exist. In consideration for being allowed to participate in the YMCA’s program, I agree to assume the risk of such exercise and further agree to defend and hold harmless the Scottsbluff Family YMCA and its staff conducting this YMCA program from any and all claims, suits, losses, or related causes of action for damages, including (but not limited to) such claims that may result from injury or death (accidental or otherwise) during, or arising in any way from the program. I also understand that the Scottsbluff Family YMCA may use, for publicity and/or promotional purposes, my (or my child’s) name or pictures participating in this program, without obligation or liability to me or my family.

eSignature

Date