Jones Private Swim Lesson Survey

1

Who are these private lessons for?* This field is required.

Adult

Child

2

Swimmer name* This field is required.

First Name

Last Name

3

Age* This field is required.

4

Gender* This field is required.

Male

Female

5

Ever done private or group swim lessons before?* This field is required.

Yes

No

6

What level is this swimmer?* This field is required.

Beginner

Intermediate

Advanced

8

What time(s) would work best for you?* This field is required.

9

When would you like to start?* This field is required.

10

What are your goals for these lessons?* This field is required.

11

Instructor request

12

Parent/Guardian Name* This field is required.

First Name

Last Name

13

Primary Phone Number* This field is required.

14

E-mail* This field is required.

15

Click to edit...* This field is required.

16

* This field is required.