Y-Readiness Program

Ready Set Swim Lesson Request Form

Today’s Date: ____________________

Participant’s Name: _________________________________________ Age: ___________

Parent’s Name: _____________________________________________________

Email: ______________________________________________________________________

Phone #: ____________________________________________________________________

Is the participant already enrolled in our Integration Initiative? Y / N

Has the child taken swim lessons with us before? Y / N

If so, when/what level were they in?

____________________________________________________________________________

Current swimming ability:

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Is there anything else we should know?

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Y-Readiness Ready Set Swim lessons

Spring 2 Schedule

6 lessons: 4/29, 5/6, 5/13, 5/20, 6/3, 6/10

*No class on 5/27 (Memorial Day weekend) or 6/17 (Father’s Day)

Rates for spring 2 session: $71/Member $107/Program Member

Please list top three preferred time frames (1 being most preferred time slot):

Sundays: ___ 12:00-12:30 ___ 12:35-1:05 ___ 1:10-1:40 ___ 1:45-2:15

___ 2:20-2:50 ___ 2:55-3:25 ___ 3:30-4:00

Please return form to Amy Turner, Amyt@hockymca.org. She will be in contact

to schedule your child’s lesson a few weeks prior to the Spring 2 session.