Request for a Make-up Lesson

Request for a Make-up Lesson

(Admit free entry)
Swimmers name

First NameLast Name
Date of Missed Lesson:
Current Stage
Current Teacher
Current Day & time
Parents name

First NameLast Name
Phone number
Please enter a valid phone number.Format: 0400000000.
Parent email
example@example.com
Provide a brief reason for your request for a make up lesson
Privacy Collection Notice: The Shire of Harvey collects personal information to respond to enquiries and deliver services. Information is managed in accordance with applicable legislation and may be disclosed where authorised or required by law. For further information, visit the Collection Notices page .

OFFICE USE ONLY

Make up lesson (day, date, time)
Teacher
Attended?	YES NO
Confirmed by SS Coordinator (Intial and date)