The YMCA believes every child should feel confident and safe around water. We are proud to offer a limited number of complimentary swim lessons to individuals who qualify.  Please fill out the information below.  If you have multiple interested participants please fill out one form for each individual. We will contact you within the next 2 weeks to update you on your application status.


* All fields required unless otherwise noted

Enter Parent Information

Address

Parent Date of Birth

Is your child on a free reduced school lunch?
How many people live in your household?
What is your household income?

Enter Participant Information

Participant 1 Date of Birth

Participant 1 Gender
Participant 1 Ethnicity

Add up to 3 additional optional participants below. If you need to add more than 3, please submit the form again with the additional participant information.

Participant 2 Date of Birth

Participant 2 Gender
Participant 2 Ethnicity

Participant 3 Date of Birth

Participant 3 Gender
Participant 3 Ethnicity

Participant 4 Date of Birth

Participant 4 Gender
Participant 4 Ethnicity