The Stephens Family YMCA (Champaign County YMCA)

Lesson Request

Thank You for filling out the private lesson request form. Lessons are for current YMCA members only. Please be advised that our current average wait time for placement with an instructor is 3 months, but this will vary depending on availability. If you have any questions please email [email protected].

* Required

Primary Contact Information

First Name *

Last Name *

Primary Phone Number *

Secondary Phone Number

Email *

Preferred Contact Method

Participant Information

First Name *

Last Name

Gender *

Age *

Skill Level *

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Preferences

Location

Special Accommodations or Requests

Objectives

General Availability

Please mark the times of the day you are generally available for lessons week to week

Packages

Select Available Package *