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New Client Inquiry From - VSL
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Your email address
Your answer
Your First name
Your answer
Your Last name
Your answer
Your phone number
*
Your answer
Are you arranging lessons/coaching for yourself?
*
Yes
No
Are you arranging lessons for one or more of your children?
*
Yes
No
Name and age of each child (Minimum age is 4 years)
Your answer
Current skill level of swimmer(s)
*
Non Swimmer
Beginner
Intermediate
Competitive
Other:
Any medical or behavioral concerns of note? If yes, please describe:
Your answer
Do you or your swimmer(s) have any special concerns?
Fear / anxiety
Breathing
Injury
Disability
What are your goals?
Overcome fear
Get comfortable in the water
Learn basic skills
Improve breathing
Refine stroke technique
Train for triathlons
Other:
Any other pertinent information?
Your answer
Your availability? Please be specific. On what days and at what times?
Your answer
Have you read through our website and watched the promotional video? The website orients you to what we do and how we do it. Please spend a little time reviewing the various sections.
Yes
No
Clear selection
Note
We are currently operating with a significant client backlog. Be patient. I will respond to your inquiry as I am able.
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