Swimming Lessons Application Form

Places

How many children do you want to register?

Child / Children's Name*

Parent / Guardian Full Name

First Last

Parent / Guardian Email*

Parent / Guardian Mobile Number*

Home Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Emergency Contact Name*

First Last

Emergency Contact Number*

For New Applications Only

Please select your preferred day

Current Swim Level

Current Day

Current Time

:

Special Needs

How did you hear about us?

Please select all that apply

Answer: 2x2=