JLS Sign Up Form
Please fill out this form COMPLETELY to request or schedule a lesson. Jonina will get back to you within 24 hours or less. Thank you!
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Email Address *
Re-type Email Address *
LEGAL First & Last Name *
Cell Phone Number *If you would like a call back please provide otherwise you will receive a response via email.*
What form of communication do you prefer to be contacted back at? *
Are you trying to schedule a: (Check ALL that apply) *
Required
What is your preferred 1st DAY to schedule your lesson? (Check ALL that apply) *
Required
What is your preferred 1st TIME to schedule your lesson between 8:00 a.m. and 7:00 p.m. CST? *
Time
:
What is your preferred 2nd DAY to schedule your lesson? (Check ALL that apply) *
Required
What is your preferred 2nd TIME to schedule your lesson between 8:00 a.m. and 7:00 p.m. CST? *
Time
:
What services are you interested in? (Check ALL that apply) *
Required
Do you have any previous experience with: *
Yes, as a student
Yes, as a teacher
No
Pole Dance Fitness
Yoga
Yoga Wheel
Yoga Trapeze
If you do have any previous experience, please indicate how many months and/or years. *
<less than 1 month
1-6 months
7-12 months
>1 year
N/A
Pole Dance Fitness
Yoga
Yoga Wheel
Yoga Trapeze
Do you have any other specific questions or concerns for Jonina? If none, please enter "N/A". *
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