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Private/Semi-Private Swim Lesson Request Form

Private/Semi-Private Swim Lesson Request Form

If you have already purchased a Private or Semi-Private Swim Lessons package, please fill out the informational form below for our instructors knowledge. If you have not purchased a package yet, please visit Membership Services or the account portal online to purchase.

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Before completing this form, have you purchased a swim lesson package at Membership Services?*
- Yes
- No
Is request form for private or semi-private swim lessons?
- Private Lessons
- Semi-Private Lessons

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Please purchase a swim lesson package
Before filling out the request form, please visit our Membership Services office or morainevalley.edu/fitrec to purchase a package online.
Would you like more information on Swim Lessons?
Please fill out your name and information and someone will be in contact with you to answer your questions.
Name
First Last
Email
Phone

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Swimmer's Information
Date*
MM slash DD slash YYYY
Swimmer's Name*
First Last
Swimmer's Date of Birth*
MM slash DD slash YYYY
Parent's Name (if swimmer is a minor)
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Please list the second swimmer's name.*
First Last
The secondary swimmer must be of similar skill set to the primary swimmer to participate in semi-private lessons. If the coach feels their skills are not compatible, individual packages will need to be purchased.
Second Swimmer's Date of Birth*
MM slash DD slash YYYY

Swimmer must be at least 4 years old.
Is the second swimmer a sibling of the primary swimmer listed?*
- Yes
- No - Secondary swimmer must fill out a separate informational request form
Membership and Swim Package Information
Is the primary swimmer a FitRec member?*
- Yes
- No
What membership type does the primary swimmer have?*
Is the secondary swimmer a FitRec member?*
- Yes
- No
What membership type does the secondary swimmer have?*
Is the parent of the swimmer a FitRec member?*
- Yes
- No
What membership type does the parent have?*
What Swim Lesson Package did you purchase?*
- Semi-Private - 1 Session
- Semi-Private - Pack of 5
- Semi-Private - Pack of 10
Semi-private lessons require the purchase of 1 session/package per swimmer.
What Swim Lesson Package did you purchase?*
- Private - 1 session
- Private - Pack of 5
- Private - Pack of 10

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Preferences & Availability
When choosing your day/time preferences, please reference the weekly pool schedule. Appointments will not be made during aqua classes and children's group lessons. The facilitator may also try to avoid bookings during busier mixed usage times.
Do you have a preference on the gender of the instructor?*
- None
- Female
- Male
Please put your preferred instructor's name in the box below.*

If you do not have a preference, please put "No Preference" in the box.
Please provide your first choice of day/time:*

Indicate if time is AM or PM
Please provide your second choice of day/time:*

Indicate if time is AM or PM
Please provide your third choice of day/time:*

Indicate if time is AM or PM

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Swim Ability & Goals
Select which is most applicable to your CURRENT swim abilities:*
- Beginner
- Intermediate
- Advanced
Do you have any swimming goals you would like to work toward (i.e. learn to swim, triathlon training, swim competition)?*
Is there any particular stroke that you feel needs improvement?*
Additional information your instructor should know:

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One-on-One Services Policies
Length of Sessions: To better service our clients, the last 5 minutes of appointments, may be used to answer questions, review skills and confirm next appointment. Private Appointment Cancellation Policy: To cancel an appointment, contact your trainer directly, at least 4 hours in advance. Failure to do so will result in forfeiting the session. Group (Semi/Duet/Trio) Cancellation Policy: In the event that one partner(s) is not able to make a scheduled appointment, there are two options available: (1) reschedule the semi-private for an alternate day/time at least 4 hours in advance OR (2) keep the regularly scheduled appointment and all partner(s) will be billed for the appointment regardless of attendance. Late Policy: Trainers will still honor the appointment in the event a client is late; however sessions that begins late will end at the originally scheduled time. Expiration Policy: All sessions/packages expire one year from date of purchase. Refund Policy: All sessions/packages are non-refundable. If dissatisfied with a trainer or trainer’s service, a client may request a replacement trainer through the Program Coordinator.
Authorization*

I certify that by typing my name in this field that I have read the policies and applicable waiver pertaining to this program, and I agree to the conditions set forth herein. Parent name is required if swimmer is a minor.
Date*
MM slash DD slash YYYY
Questions?
Please contact Ewan Gall at galle2@morainevalley.edu or (708) 608-4207 if you have any questions.

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Health, Fitness and Recreation Center

9000 W. College Parkway
Building H
Palos Hills, IL 60465