Aquatics Private Lessons Request Form

Parent's First Name
Parent's Last Name
Child's Name
Child's Age
Briefly explain what you would like
your child to accomplish with swim lessons.
Does your child have any medical conditions,
special needs, or any background information
that will help us to determine the best
instructor and approach?
Preferred Time and Day of Week
Other Times/Days Available
Choose Your Instructor (Leave Blank if No Preference)
 Janet Strimel
 Melanie Rosen
 Karla Stoll

Please read the policies listed below for all private and semi-private swim lessons to be held at the Evelyn Rubenstein JCC.

Payment Policy

  • Payment must be made before the 1st lesson, no exceptions.

Cancellation Policy

  • Cancellations must be made at least 24 hours in advance in order to be credited with a make up lesson (Unless a written medical note is provide prior to or at the next lesson)
  • Cancellation must be made by contacting the instructor by phone or email.
  • If a student does not show up to a scheduled lesson without prior required notification, the lesson will be forfeited. One forfeited lesson per 5 purchased lessons may be made-up at a cost of 50% of the original lesson
  • In case of a family emergency (sudden illness, family emergency) immediately contact Lee Hutchens at or 713.595.8193. The decision on rescheduling the lesson will be at the discretion of the Aquatics Director.

Time Completion Requirement Policy

  • Private and Semi-private Lesson packages and all make-up lessons must be completed within the following preset time period from the date of the first lesson:
  • 7 weeks for a five (5) lesson package
  • 12 weeks for a ten (10) lesson package
  • 6 months for a twenty (20) lesson package
  • After the preset time period, any unused lessons will expire.
  • Semi-private lessons will follow the same procedures as private lessons. (If one of the semiprivate student attends, then it is counted as a completed lesson and the student missing the lesson is NOT credited with another lesson)

Tardiness Policy

  • Lessons will begin and end promptly; extra time will not be added to the end of the lesson unless the delay was instructor related.
  • Please plan on arriving 10-15 minutes early to allow your child time to stop by the bathroom, get changed and get their equipment ready before the lesson begins.

****All questions and concerns regarding your child’s lessons must be sent to the Instructor via email or cell phone. Our lessons are scheduled back to back and our instructors need the time between students to get ready for the next student. 

Your Initials
 I understand and agree to all of the policies listed above.