LEARN
HOW TO
SWIM
Swimming Lessons
SOUTHWEST YMCA
September – December 2014
Parent/Child . Preschool . Youth & Adult
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SOUTHWEST YMCA 13500 Quito Road, Saratoga, CA 95070 | P 408 370 1877 F 408 370 1333 | swymca.org
What Level is My Child?
Each level is based on age and/or skill.
Classes are 40 minutes.
Parent/Child (Ages 6 Months - 3 Years Old)
Parents learn to work with their children in the water.
This class focuses on safe water exploration and working
on water adjustment.
GUPPY (Youth Beginner II, 1:6 Ratio)
• Can your child swim 25 yards of front crawl with rotary
breathing?
• Can your child swim 25 yards of backstroke?
•Can your child swim 25 yards of elementary backstroke?
No to any questions? Enroll in Guppy
Yes to all questions? Move on to Minnow
MINNOW (Youth Intermediate I, 1:8 Ratio)
• Is your child comfortable in the water?
• Will your child willingly put his or her head under water on a
consistent basis?
• Will your child comfortably lay on his or her front and back
while supported in the water, staying relaxed?
No to any questions? Enroll in Pike
Yes to all questions? Move on to Eel
• Can your child swim 50 yards of each of the following
strokes?
- Freestyle
- Backstroke
- Breaststroke
• Can your child perform the scissor kick?
• Can your child perform the dolphin kick?
• Can your child perform an open turn?
No to any questions? Enroll in Minnow
Yes to all questions? Move on to Fish
EEL (Preschool Intermediate, 1:5 Ratio)
FISH (Youth Intermediate II, 1:8 Ratio)
• Can your child float on his or her front without assistance?
• Can your child float on his or her back without assistance?
• Can your child move forward on his or her front using arms
and legs without assistance?
• Can your child move forward on his or her back using legs
without assistance?
No to any questions? Enroll in Eel
Yes to all questions? Move on to Ray/Starfish
• Can your child swim 100 yards of the following?
- Freestyle with alternate breathing and body rotation
- Backstroke with body rotation
- Breaststroke
• Can your child swim sidestroke?
No to any questions? Enroll in Fish
Yes to all questions? Move on to Flying Fish
FLYING FISH (Youth Advanced, 1:10 Ratio)
RAY/STARFISH (Preschool Advanced, 1:5 Ratio)
Adult Classes
PRESCHOOL LEVELS (Ages 3–5 Years Old)
PIKE (Preschool Beginner, 1:5 Ratio)
• Can your child swim independently on his or her front with
face in the water demonstrating the ability to take a breath
without stopping 12.5 yards?
• Can your child swim independently on his or her back using
arms and legs for 12.5 yards?
No to any questions? Enroll in Ray/Starfish
Yes to all questions? Move on to Minnow
YOUTH LEVELS (Ages 6-14 Years Old)
POLLIWOG (Youth Beginner I, 1:6 Ratio)
• Can your child float on his or her front without assistance?
• Can your child float on his or her back without assistance?
• Can your child swim independently on his or her front with
face in the water demonstrating the ability to take a breath
without stopping?
• Can your child swim independently on his or her back using
arms and legs?
No to any questions? Enroll in Polliwog
Yes to all questions? Move on to Guppy
Age: 14 and older
Anyone interested in learning to swim or improving their
stroke technique.
Swimming Lessons
To Register
Complete the attached registration form and submit
with payment. Checks and credit cards will be accepted
at registration. Facility Members can sign up at any time
and Program Members can sign up two weeks prior to
the session start date. Incomplete registrations will not
be processed. No make-ups for missed classes.
Financial Assistance
YMCA memberships and programs are open to everyone.
Financial assistance is available. To apply, pick up a
confidential application at our YMCA.
Contact Us
For general YMCA Swim Lesson questions, call
Southwest YMCA at 408 370 1877. For specific
questions call the Aquatics Office at 408 608 6814.
Swimming Lessons Registration Form
SOUTHWEST YMCA
13500 Quito Road, Saratoga, CA 95070
P 408 370 1877 F 408 370 1333 | swymca.org
PARTICIPANT’S INFORMATION (Use a separate form for each participant.)
Participant’s Name:
Birthdate:
Age:
o Female o Male
Does the participant require any accommodations for this activity? o Yes o No
If “Yes” please explain:
PRIMARY CONTACT
Parent/Guardian Name: Birthdate:Email:
Home Phone:
Emergency Phone:
Address:City/State/ZIP:
SECONDARY CONTACT
Parent/Guardian Name: Emergency Phone:
Email is one of the fastest, most cost-effective, and environmentally friendly ways for us to communicate with you. We would like to send you
periodic emails and automated phone calls with Y news and special offers. We will never share or sell your email, phone number or address to any third
party. You may unsubscribe at any time.
Please do NOT communicate with me by: o Email o Phone
Which level is the participant?
o Parent/Child o Pike o Eel o Ray/Starfish o Polliwog o Guppy o Minnow o Fish o Flying Fish o Adult
SESSION DATES
4 WEEK SESSION (Twice a week classes)
8 WEEK SESSION (Once a week class)
4 WEEK SESSION
MON & WED
SATURDAY ONLY
o September 8 – October 2
o 3:30 – 4:10 pm
Preschool/Youth
o 9:30 – 10:10 am
Parent/Child and Preschool
o October 6 – 30
o 4:15 – 4:55 pm
Preschool/Youth
o 10:15 – 10:55 am
Youth
o November 3 – 26*
*No Lessons on Thurs., Nov. 27
o 5:00 – 5:40 pm
Preschool/Youth
o 11:00 – 11:40 am
Parent/Child and Preschool
o 5:45 – 6:25 pm
Preschool/Youth
o 11:45 – 12:25 pm
Youth
8 WEEK SESSION
TUES & THURS
o 12:30 – 1:10 pm
Adult
o September 6 – October 26
o 3:30 – 4:10 pm
Preschool/Youth
SUNDAY ONLY
o November 1 – December 20
o 4:15 – 4:55 pm
Preschool/Youth
o 10:30 – 11:10 am
Preschool
o 5:00 – 5:40 pm
Preschool/Youth
o 11:15 – 11:55 am
Youth
TYPE OF MEMBERSHIP
o Facility Member
PRICE
o Program Member
Lesson Fee
$
OUR FEES
$25 Annual Program
Membership Fee
(waived if you are a
$
o Facility Members
Nov. (4 Week Session )
* o Tues
& Thurs Only
$96
$84
o Program Members
ov. (4 Week Session)
* o NTues
& Thurs Only
$192
$168
Total
PAYMENT INFORMATION
o My check or money order is enclosed.
Charge my: o Visa o Mastercard o American Express o Discover
Account Number:
Name of Cardholder:
Signature:
Facility Member)
Exp. Date:
$
Swimming Lesson Guidelines
• Shower before entering the water.
• Pull long hair back in a braid, ponytail or cap.
• Swim suits and/or swim shorts must be worn.
• No swimsuits with built-in life jackets.
•Purchase swim diapers in advance at a
retail store.
• Observers are not allowed on the pool deck.
•Under certain conditions, lessons will be
altered to a dry land class teaching water
safety, pool rules and swimming etiquette.
•Children under 12 must have a parent/guardian
present in the YMCA while swim lessons are in
progress.
• Photographs can be taken of your child, only.
No video recording.
If you have any concerns, be sure to
communicate with the instructor
before or after class.
MEMBERSHIP, PAYMENT AND CANCELLATIONS/TRANSFERS
• All programs have a minimum enrollment. Programs not reaching
minimum enrollment will be cancelled. In this case, you will have
the option of receiving a full refund or credit or switching to
another similarly priced program or class, if available, at no extra
charge.
• There are no make-ups for missed classes, whether your child is
sick, out of town or unable to attend. Your child may not attend
a class at another time slot in place of a missed class. You do not
need to call the YMCA if your child will be missing a class.
• Transfers/Cancellations If a participant withdraws prior to the
first class, a refund minus a $15 processing fee will be issued.
If a participant participates in one class then withdraws, a
refund for the pro-rated amount of the class fee (from the date
the request was submitted minus a $15 processing fee) will be
issued. No refunds will be distributed beyond the second class of
any program/class without a doctor’s note. If a doctor’s note is
provided, a refund for the pro-rated amount of the class fee (from
the date requested) will be issued.
Transfers: Transfers can be made, if space is available but are
not guaranteed.
OFFICE
USE
Rec’d by
Date
• If you receive a credit, it is valid for 6 months from the start of
the original program/class for which you registered.
• Program Membership: Each child needs to have a Program or
Facility Membership. If the child is not a member, a $25 Program
Membership fee is required. Program Membership fee is nonrefundable.
• Photo Release: I hereby irrevocably consent to and authorize the
use and reproduction by the YMCA, or anyone authorized by the
YMCA, or any photographs which you have this day taken of me or
my child, negative or positive, for any purpose whatsoever without
compensation to me. All negatives and positives, together with the
print, shall constitute the YMCA’s property, solely and completely.
• I understand and accept the above policies.
Parent/Guardian Signature
Entered by
Date
Date
YMCA of SILICon VALLEY
Release and Waiver of Liability and Indemnity Agreement
IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the YMCA (or for my children to so participate) for
any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated
with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of
kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully
consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use
of any facilities or equipment or participation in such affiliated program constitutes an acknowledgment that such premises and all facilities
and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts
same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO
OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE
UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
1. THE UNDERSIGNED, ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES
AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (hereinafter referred to as “releases”)
from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any
loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the
undersigned, whether caused by the negligence of the releases or otherwise while the undersigned or such children is in, upon,
or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA.
2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from
any loss, liability, damage or cost they may incur due to the presence of the undersigned or such children in, upon or about
the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program
affiliated with the YMCA whether caused by the negligence of the releases or otherwise.
3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY
DAMAGE to the undersigned or such children due to negligence of releases or in, about or upon the premises of the YMCA and/
or while using the premises or any facilities or equipment thereon or otherwise while participating in any program affiliated
with the YMCA.
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad
and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance
shall, notwithstanding, continue in full legal force and effect.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and
further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.
I HAVE READ THIS RELEASE.
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Signature of Applicant/Parent
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Print Name of Applicant/Parent
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Signature of Applicant/Parent
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Print Name of Applicant/Parent
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Date
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Date
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Date
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Date
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Print Name of Child in Program
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Print Name of Child in Program
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Print Name of Child in Program
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Print Name of Child in Program
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Date
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