Adult Learn to Swim Form

Please complete one per adult. As part of the Bangor Region YMCA’s commitment to keeping everyone safe in and around water, we are expanding our reach by providing FREE SWIM LESSONS for ADULTS!. Our Y is able to provide this amazing opportunity due to funding we received from the 2026 USA Swimming Foundation Learn to Swim Grant! FUNDS ARE LIMITED. APPLY EARLY!

Which session are you interested in?(Required)

Participant's Information

Name(Required)
Address(Required)
Sex(Required)
Are you currently a member of the Bangor Region YMCA?(Required)
Is transportation to and from the YMCA for the swim lessons a concern?(Required)
Is your immediate family or extended family currently being impacted or has been impacted by opioid and/or substance use disorder?(Required)

Emergency Contact Information

Emergency Contact(Required)

Swimming Ability

Are you fearful of the water or have had a traumatic experience?(Required)
Have you previously taken swim lessons?(Required)
If yes, was it at the Bangor Region YMCA?
Can you float independently?(Required)
Do you know any of the 4 swim strokes (front crawl, breaststroke, backstroke & butterfly)?(Required)
What strokes do you want to work on?(Required)
Certificaton of Information(Required)