Learn to Swim

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Parent name

First

Last

Date of birth

EG: 1/12/1999

Address

Mobile number

Email address

How did you hear about us?

If you've selected 'Others', please specify how you heard about us

Emergency contact name

Emergency contact relationship to you

Emergency contact number

Child 1 Full Name

First

Last

Date of birth (Child 1)

EG: 1/12/1999

What swimming experience does your child have? (Child 1)

EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…

Child 2 Full Name

First

Last

Date of birth (Child 2)

EG: 1/12/1999

What swimming experience does your child have? (Child 2)

EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…

Child 3 Full Name

First

Last

Date of birth (Child 3)

EG: 1/12/1999

What swimming experience does your child have? (Child 3)

EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…

Child 4 Full Name

First

Last

Date of birth (Child 4)

EG: 1/12/1999

What swimming experience does your child have? (Child 4)

EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…