STEP 1 | Primary Contact InformationPrimary Contact Name* Cell Phone Number* Email* Contact Preference* AnyCellTextEmailReferred By FacebookYelpInternetFriend[group friend-selected]Friend's Name [/group]STEP 2 | Student InformationStudent's Name* Student's Birthdate* Student's Age* Has the student had swim lessons in the past?* YesNo[group student-one-swim-lessons-yes-selected]Was it with a swim school or instructor OTHER than Water Otters? YesNo[/group][group student-one-other-school-yes-selected]What is the name of the swim school? [/group]Our Lead Instructor, Jennifer, is now concentrating on teaching adult swimmers, very young children (under 24 months), and students with specific needs. If your student(s) does not meet these criteria, they may be assigned to an instructor other than Jennifer. Please be confident that all team members are highly qualified and trained by Jennifer in the Water Otters Method.Since rates for the Lead Instructor are not reflected on this form please visit Lead Instructor Pricing and Information for rates and additional information.Please note, if you have an instructor preference, we will do our best to accommodate your request.Are you requesting a specific instructor? YesNo[group student-one-instructor-preference-yes-selected]Please select your instructor preference Jennifer, Lead Instructor (available at the end of May)Other highly trained Water Otters Instructor[/group]My student is an adult, under 24 months, or a student with specific needs. YesNoI don't know[group student-one-special-needs-idk-selected]Specific 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)[/group][group student-one-special-needs-yes-selected]Is there additional information that would help the instructor understand the student's specific needs? YesNo[/group][group student-one-special-needs-addl-yes-selected]Please select the student'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 begin[/group]Would you like to add a second student? YesNo [group second-student-yes-selected]STEP 2 | Student #2 InformationStudent #2's Name* Student #2's Birthdate* Student #2's Age* Has student #2 had swim lessons in the past?* YesNo[group student-two-swim-lessons-yes-selected]Was it with a swim school or instructor OTHER than Water Otters? YesNo[/group][group student-two-other-school-yes-selected]What is the name of the swim school? [/group]Our Lead Instructor, Jennifer, is now concentrating on teaching adult swimmers, very young children (under 24 months), and students with special needs. If your student(s) does not meet these criteria, they may be assigned to an instructor other than Jennifer. Please be confident that all team members are highly qualified and trained by Jennifer in the Water Otters Method.Since rates for the Lead Instructor are not reflected on this form please visit (insert link here) for rates and additional information.Please note, if you have an instructor preference, we will do our best to accommodate your request.Are you requesting a specific instructor for student #2? YesNo[group student-two-instructor-preference-yes-selected]Please select your instructor preference for student #2 Jennifer, Lead InstructorOther highly trained Water Otters Instructor[/group]Student #2 is an adult, under 24 months, or a student with specific needs. YesNoI don't know[group student-two-special-needs-idk-selected]Specific 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)[/group][group student-two-special-needs-yes-selected]Is there additional information that would help the instructor understand the student #2's specific needs? YesNo[/group][group student-two-special-needs-addl-yes-selected]Please 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 begin[/group] [/group]Would you like to add a third student? YesNo [group third-student-yes-selected]STEP 2 | Student #3 InformationStudent #3's Name* Student #3's Birthdate* Student #3's Age* Has student #3 had swim lessons in the past?* YesNo[group student-three-swim-lessons-yes-selected]Was it with a swim school or instructor OTHER than Water Otters? YesNo[/group][group student-three-other-school-yes-selected]What is the name of the swim school Student #3 attended? [/group]Our Lead Instructor, Jennifer, is now concentrating on teaching adult swimmers, very young children (under 24 months), and students with specific needs. If your student(s) does not meet these criteria, they may be assigned to an instructor other than Jennifer. Please be confident that all team members are highly qualified and trained by Jennifer in the Water Otters Method.Since rates for the Lead Instructor are not reflected on this form please visit (insert link here) for rates and additional information.Please note, if you have an instructor preference, we will do our best to accommodate your request.Are you requesting a specific instructor for student #3? YesNo[group student-three-instructor-preference-yes-selected]Please select your instructor preference for student #3 Jennifer, Lead InstructorOther highly trained Water Otters Instructor[/group]Student #3 is an adult, under 24 months, or a student with specific needs. YesNoI don't know[group student-three-special-needs-idk-selected]Specific 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.[/group][group student-three-special-needs-yes-selected]Is there additional information that would help the instructor understand the student #3's specific needs? YesNo[/group][group student-three-special-needs-addl-yes-selected]Please 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 begin[/group] [/group]STEP 3 | Pool PreferenceWould you like the lessons to take place at the Water Otters Pool located in Winnetka? YesNo [group wo-pool-yes-selected]Great! The specific pool address will be provided after registration and payment have been received.[/group][group wo-pool-no-selected]Would you like the lessons to take place at your pool? YesNo[group your-pool-yes-selected]What type of pool do you have? Private Residence PoolPrivate Facility Pool (Apt or Condo)[group pool-type-private-residence-selected]Please note, acceptable options are either your pool or a family member's pool.[/group][group pool-type-private-facility-selected]Please note, we only teach in pools that are located at single residence homes and privately owned.[/group]Is your pool heated? YesNo[group pool-heated-no-selected]Please note, we only teach in pools heated between 88-92 degrees. This temperature range is critical so that the focus of the lesson can be on learning and enjoyment.[/group]What is the pool address? [/group][/group]STEP 4 | Session PreferencePrivate lessons begin at the end of March and run through the end of September.• 3 Week Session: 20-minute private lessons three times a week (for 3 consecutive weeks) • Package Price of $405 (9 lessons total) *Sessions are pro-rated when a holiday occurs. • Each week, lessons will be on Monday, Wednesday and Friday.Please know that lessons in the early summer months are the most popular.Select as many Sessions as possible that would work for your family as the more options you give us the better chance you have of securing your desired Session(s).Typically, families sign up for 2 or more Sessions each season.Spring Break Clinic weeks are during Session #2. If you would like to participate in the 1st, 2nd, or 3rd week (or any combination of weeks) please select Session #2 and then indicate your desired weeks in the comment box below.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 to secure your desired preferences.Which Session(s) would you like? Please select as many as possible. Session #1 (March 21 - April 8)Session #2 (April 11 - April 29) Spring Break ClinicsSession #3 (May 2 - May 20)Session #4 (May 23 - June 10)Session #5 (June 13 - July 1)Session #6 (July 4 - July 22)Session #7 (July 25 - August 12)Session #8 (August 15 - September 2)Session #9 (Sept 5 - September 23)How many of the above selected Sessions would you like?AllSomeIf the sessions I have selected above are unavailable I would like to indicate my 2nd choice. YesNo[group second-choice-yes-selected]Please indicate which alternative session(s) might work for your schedule. [/group]Please add my email to the waiting list and informational newsletter if my preferences are unavailable.YesNo[group wait-list-yes-selected]If you are on the waitlist, when would you like lessons? ASAPAnytimeMayJune or JulyAugust or September[/group]Do you have comments, questions, or need more information from Water Otters (i.e. how many sessions would be appropriate for your family) Or do you need more information from someone else before choosing a Session? (i.e. camp schedule, or travel plans)? YesNo[group session-ques-info-yes-selected]Please indicate your comments or questions in the box below. [/group]Private 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 student(s)? YesNo [group tues-thur-yes-selected]If the Tuesday, Thursday schedule becomes an option, we will be sure to contact you.[/group]STEP 5 | 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.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 time spots. Please know that late afternoon lesson times are the most popular.Do you have a time preference? YesNo[group time-pref-yes-selected]Please select as many times as possible.Would you like Morning (9:00 AM - 11:40 AM)? YesNo[group morning-yes-seleced]Please select as many times as possible. 9:00 AM9:20 AM9:40 AM10:00 AM10:20 AM10:40 AM11:00 AM11:20 AM11:40 AMAll[/group]Would you like Early Afternoon (12:00 PM - 2:40 PM)? YesNo[group early-afternoon-yes-selected]Please select as many times as possible. 12:00 PM12:20 PM12:40 PM1:00 PM1:20 PM1:40 PM2:00 PM2:20 PM2:40 PMAll[/group]Would you like Late Afternoon (3:00 PM - 7:00 PM)? YesNo[group late-afternoon-yes-selected]Please 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 PMAll[/group][/group]Do you have comments, questions, or need more information from Water Otters before choosing your time preferences? Or do you need more information from someone else before choosing a time? (i.e. camp schedule, or travel plans) YesNo[group time-ques-info-yes-selected]Please indicate your comments or questions in the box below. [/group]Is there anything else you would like us to know? YesNo[group anything-else-yes-selected]Please indicate your comments or questions in the box below.[/group]Please read carefully and check each box.I understand that there are no makeups or refunds for missed private lessons for any reason (NO exceptions). I understand that instructor preference can be noted but may not be guaranteed. I understand that payment in FULL (for all lessons scheduled) is due upon registration. I understand that openings on the swim schedule are subject to availability and fluctuate daily. I understand that submitting this form does not guarantee lesson dates or times. I understand that after my Schedule Request Form has been received, I will be contacted with current available lesson dates and times as well as information about how to register, pay, and secure my desired lesson times. The specific pool address will be provided after payment has been made.
