Infant Swimming Resource
Cindy Horrocks, Certified Instructor
Lesson Request Form
Parent Full Name:
Child Full Name:
Birth date:
New Student
 Refresher
 Stroke
Child  2 Full Name:
Birth date:
New Student
 Refresher
 Stroke
Child  3 Full Name:
Birth date:
New Student
Refresher
Stroke
Mailing Address:
Zip Code
City
 State
Phone:
Cell
Home
e-mail address:
Choose month to
begin lessons:
June
 July
All lesson dates and time are subject to availability.  
Lessons times may be expanded or limited depending
on demand. Lesson times will be reserved on a first
come first served basis based on time National
Registration Form is received.
How did you learn
about ISR lessons?
Comments:
ISR Non-Discrimination Policy

Infant Swimming Resource, LLC ("ISR") complies with all federal and state laws and
regulations and does not unlawfully discriminate on the basis of race, color, national
origin, gender, age, religion or disability. It is the policy of ISR to provide reasonable
accommodations to its disabled applicants and students, with the provision of
appropriate documentation of the need for the accommodation.
Notice: As of June 2, 2011 all lesson slots are FULL. Openings
available starting May 2012.