Swim Lessons Waitlist Form

Thank you for your interest in our Swimming Lessons at the Springfield JCC! While we work hard to grow and refine our swim programs, please fill this form out to be added to our waitlist.

**Please note: this is NOT a registration form and by filling this form out it does NOT guarantee your spot in lessons.**

**Please note: For private and semi-private lessons, we will contact you directly when instructors have availability that match your availability **

If you have any questions, please reach out to Leonor via their contact information below.

Thank you!

Aquatics Department

Leonor Ayala-Sanchez

Aquatics Manager

layalasanchez@springfieldjcc.org

Swimmer's Info

Swimmer's First Name

Swimmer's Last Name

Swimmer's Age

Describe the swimmer's experience level:

Does the participant swim with flotation devices (bubbles, noodles, coast guard approved lifejacket, etc)? If yes, please include what type of flotation devices.

Parent/Guardian's Info

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Additional Questions

Are you a Springfield JCC member?

Yes No

If you currently are NOT a member, are you interested in becoming one?

Yes No

Are you interested in Private, Semi-Private or Group Lessons?

Private Semi-Private Group

For Private/Semi-Private Lessons, please provide your availability (days and times)

Please explain or offer any additional information you feel the program staff should be aware of for your safety and comfort.

Swimmer's Info

Parent/Guardian's Info

Additional Questions

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