JCC MidWestchester Swim Assessment Request -

Swim Lesson Evaluation Request

Thank you for your interest in JCC of Mid-Westchester’s Aquatics Program. We require an evaluation before registration for any new students. We will get back to you within 2 business days to schedule your child's evaluation. Marlena Rykala JCCMW Aquatics

Today's date
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Child's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Parent/Guardian's Name*
First Last
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Best Phone Number to Contact You*
Your Email*
Please describe your child's swimming abilities and goals and any prior instruction:
Please list three Days and Time for an evaluation*

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