Swim Lesson Sign Up Form
Please answer the questions to the best of your ability and our Aquatics Coordinator will reach out to you as soon as possible to get your student signed up for the appropriate class.

Questions? Feel free to reach out to our Aquatics Coordinator McKenzie Shaw
Email: mckshaw@grantspassymca.net
Phone: (541)-916-5777 or (541)-474-0001
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Email *
Student Name and Age *
Guardian Name and Phone Number *
Preferred Method of Contact *
Required
Type of Lesson *
Required
Has the student been in swim lessons at the YMCA before? (If yes what stage were they in?) *
Can the student participate in a group setting? *
Is the student comfortable getting their face and ears wet? *
Can the student get in the water without panicking? *
Has the student been in a pool before? *
Can the student float on their back with assistance for 5 seconds? *
Can the student glide (straight arms out in front of them with their hands together) with their face in the water? *
Can the student bob (jump up and down in the water) on their own? *
Can the student float on their back on their own for 10 seconds? *
Can the student go all the way underwater? *
Can the student roll on their back from gliding on their own? *
Can the student swim on their front using their arms and legs with their face in the water? *
Can the student swim on their back using their arms and legs? *
Can the student comfortably jump in the deep end and return to the wall?  *
Can the student swim 1 full length (25 yards) of the pool? *
Can the student swim front crawl with breathing to their side? *
Does the student know how to do butterfly/dolphin and breaststroke kick? *
Can the student swim front crawl with side breathing for 1 full length (25 yards) of the pool? *
Can the student swim back crawl for 1 full length (25 yards) of the pool? *
Is the student familiar with how to swim butterfly and breaststroke? *
Write down the times and days you are available for lessons (mark separately which times and days you would prefer*)

*We cannot guarantee that you will get your preferred times and days
 *
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