ISR Jennifer Winsbro WAITLIST Contact Form

1
Guardian's Name* This field is required.
First Name
Last Name
2
Child's Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Area Code
Phone Number
5
Child's Age* This field is required.
6
My child is a....* This field is required.
First Time Student
Refresher Student
7
Do you have another child (or children) taking ISR lessons with me?* This field is required.
YESNO
8
Please provide the name(s) and age(s) of siblings currently enrolled or to be enrolled in ISR lessons with me:* This field is required.This allows me to schedule your children's lessons back to back.
9
I understand that these private, one-on-one ISR lessons occur for 10 minutes, five days a week (M-F) and continue until children are able to demonstrate reliable self-rescue skills (approximately 6 weeks).* This field is required.For more detailed information on ISR lessons please visit www.infantswim.com
Agree
10
Please tell me about your availability. * This field is required.If you are only available after a certain time of day or certain days of the week, please provide that information here. This information ensures a smooth scheduling process.
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Ok
Ok
11
How did you hear about us?
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Small
Ok
Ok
12
If a friend or family member recommended me, please tell me who I should thank!
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