Test 2023 Contact Form STEP 1 | Primary Contact InformationPrimary Contact Name* Cell Phone Number* Email* Contact Preference AnyCellTextEmailWe are a returning family from 2022* YesNoIf you are a new family, how were you referred? FacebookYelpInternetFriendFriend's Name STEP 2 | Student DetailsStudent's Name* Student's Current Age (must be 20 months or older) Student's Birthdate* Has the student had swim lessons in the past?* YesNoWas it with a swim school or instructor OTHER than Water Otters? YesNoWhat is the name of the swim school? Is there a pool to practice in where you live?* YesNoHas the student been wearing floaties (or any type of buoyancy device)?* YesNoHow does the student feel about water on their face?* No ProblemDoesn't like itHates itDon't knowMy student is an under 24 months, or an adult, or a student with specific needs. YesNoI don't knowSpecific needs may include sensitivities to touch or sound, receiving speech or other types of therapies, has a school-issued IEP, prior water trauma, or negative swim lesson experience.Is there additional information that would help the instructor understand the student's specific needs? YesNoPlease select the student's specific need(s) and Water Otter's Team Member will contact you privately before lessons begin in order to get more details and discuss any specific concerns you may have. Sensitive to touch or soundReceives speech or other types of therapiesHas a school-issued IEPPrior water trauma or negative swim lesson experienceOtherWould you like to add a second student (a 10% discount applies for each additional sibling)? YesNoSTEP 2 | Student #2 InformationStudent #2's Name* Student #2's Birthdate* Student #2's Age* Has student #2 had swim lessons in the past?* YesNoWas it with a swim school or instructor OTHER than Water Otters? YesNoWhat is the name of the swim school? Has the student been wearing floaties (or any type of buoyancy device)? YesNoHow does the student feel about water on their face? No ProblemDoesn't like itHates itDon't knowStudent #2 is an adult, under 24 months, or a student with specific needs. YesNoI don't knowSpecific needs may include sensitivities to touch or sound, receiving speech or other types of therapies, prior water trauma, or negative swim lesson experience)Is there additional information that would help the instructor understand the student #2's specific needs? YesNoPlease select the student #2's specific need(s) Sensitive to touch or soundReceives speech or other types of therapiesHas a school-issued IEPPrior water trauma or negative swim lesson experienceOtherI prefer to discuss my student's specific needs in more detail privately with a Water Otter's Team Member before lessons beginWould you like to add a third student? YesNoSTEP 2 | Student #3 InformationStudent #3's Name* Student #3's Birthdate* Student #3's Age* Has student #3 had swim lessons in the past?* YesNoWas it with a swim school or instructor OTHER than Water Otters? YesNoWhat is the name of the swim school Student #3 attended? Has the student been wearing floaties (or any type of buoyancy device)? YesNoHow does the student feel about water on their face? No ProblemDoesn't like itHates itDon't knowStudent #3 is an adult, under 24 months, or a student with specific needs. YesNoI don't knowSpecific needs may include sensitivities to touch or sound, receiving speech or other types of therapies, prior water trauma, or negative swim lesson experience.Is there additional information that would help the instructor understand the student #3's specific needs? YesNoPlease select the student #3's specific need(s) Sensitive to touch or soundReceives speech or other types of therapiesHas a school-issued IEPPrior water trauma or negative swim lesson experienceOtherI prefer to discuss my student's specific needs in more detail privately with a Water Otter's Team Member before lessons beginSTEP 3 | Session Date PreferencePrivate Lesson Package Information• Each Session is 3 weeks. • Each week, lessons will be on Monday, Wednesday and Friday. • Each lesson is 20-minutes. • Package Price is $405 (9 lessons total) *Sessions are pro-rated when a holiday occurs. Private Lessons begin at the end of March and continue through the end of September (see specific date options below).You must be available for all 3 weeks of each session(s) you are signing up for.We understand that your summer plans may be undecided at this time, but please know the schedule fills up quickly. The sooner you can get us your information the more likely you will be able to secure your desired preferences.How many 3 week Sessions would you like to sign up for? Typically, families sign up for 2 or more Sessions each season.*1 Session2 Sessions3 SessionsUndecidedWhich Session(s) would you like? Please select all Sessions you are available (if the selected sessions are full, we will do our best to offer you your second choice indicated in the next question).* Session #4 (May 22 - June 9)Session #5 (June 12 - June 30)Session #6 (July 3 - July 21)Session #7 (July 24 - August 11)Session #8 (August 14 - September 1)Session #9 (Sept 4 - September 22)If the Sessions I have selected above are unavailable I would like to indicate my 2nd choice. YesNoPlease indicate your second choice (and/or any additional notes) in the box below. Please add me to the wait list if my preferences are unavailable.YesNoPrivate Lessons are typically Monday, Wednesday, and Friday (3 days a week). If we were to open a Tuesday, Thursday (2 days a week) schedule option, would that work for your family? YesNoIf the Tuesday, Thursday schedule becomes an option, we will be sure to contact you.STEP 4 | Time PreferenceWe suggest choosing times when the student(s) are most awake and alert. Times that do NOT occur too close to nap or meal times are ideal.Remember to account for travel and transition time from other activities and PLEASE PLEASE PLEASE be sure that times selected accurately reflect when you are available.Do you have a time preference?* YesNoPlease select as many times as possible that would work for your family as the more options you give us the better chance you have of securing your desired times. Please know that late afternoon lesson times are the most popular.Would you like Morning (9:00 AM - 11:40 AM)? YesNoPlease select as many times as possible. 9:00 AM9:20 AM9:40 AM10:00 AM10:20 AM10:40 AM11:00 AM11:20 AM11:40 AMAllWould you like Early Afternoon (12:00 PM - 2:40 PM)? YesNoPlease select as many times as possible. 12:00 PM12:20 PM12:40 PM1:00 PM1:20 PM1:40 PM2:00 PM2:20 PM2:40 PMAllWould you like Late Afternoon (3:00 PM - 7:00 PM)? YesNoPlease select as many times as possible. 3:00 PM3:20 PM3:40 PM4:00 PM4:20 PM4:40 PM5:00 PM5:20 PM5:40 PM6:00 PM6:20 PM6:40 PM7:00 PMAllWould you like to add any additional notes or questions? YesNoPlease indicate your comments or questions in the box below.STEP 5 | AcknowledgmentsPlease read carefully and check each box.There are no makeups or refunds for missed private lessons for any reason (NO exceptions). Instructor preference may be noted but cannot be guaranteed. Payment in FULL (for all lessons scheduled) is due upon registration in order to secure your spot. Openings on the swim schedule are subject to availability and fluctuate daily. Submitting this form does not guarantee lesson dates or times. Our lessons are fun, relaxed, play-based, developmentally appropriate, and taught at the child's pace. We don't rush a student's progress. After my Schedule Request Form has been received, I will be contacted with available lesson dates and times as well as information about how to register, pay, and secure my desired lesson times. The Winnetka pool address will be provided after payment has been made.
