The Swim Lab Trial Registration Form (Upated)

1

Which program are you interested in?* This field is required.

Learn to Swim (Kids)

Learn to Swim (Adults)

3

Please share the details for the person that referred youParent Name or Guardian's Name

First Name

Last Name

4

Which location are you interested in?* This field is required.

The Swim Lab @ Hwa Chong Institution (Bukit Timah)

The Swim Lab @ NTUAC (Buona Vista)

5

Which location are you interested in?* This field is required.

The Swim Lab @ Hwa Chong Institution (Bukit Timah)

The Swim Lab @ NTUAC (Buona Vista)

Other

6

Parent/Guardian's Name* This field is required.

First Name

Last Name

7

Parent/Guardian's NRIC/FIN/Passport * This field is required.

Last 3 digits + letter (Ex. 123X)

8

Email* This field is required.

Important updates will be sent to this email

9

Phone Number* This field is required.

WhatsApp updates will be sent to this number

10

Swimmer's Postal Code

11

Swimmer's Name* This field is required.

First Name

Last Name

12

Swimmer's preferred name * This field is required.

How would you like us to address your child

13

Swimmer's NRIC/Passport/FIN* This field is required.

Last 3 digits + letter (Ex. 123X)

14

Swimmer's Gender* This field is required.

Male

Female

15

Swimmer's Date of Birth * This field is required.

16

Emergency Contact Name* This field is required.

First Name

Last Name

17

Emergency Contact Number* This field is required.

Please enter a valid phone number.

18

Does he/she have any swimming experience? If any, please specify what strokes he/she is able to do.Put N/A if he/she is new to swimming

19

Do you have any swimming experience? If any, please specify.Put N/A if yo are new to swimming

20

Private Session

Please email us at info@theswimlab.com, or you can give us a call at +65 9646 3655 to book a private session

You may also click her to message us via WhatsApp

21

Terms and Conditions (Please Read)* This field is required.

22

INDEMNITY FOR MINORS
The section below must be completed by the parent/guardian of the swimmer below the age of 21

I, {parentguardiansName}, NRIC No. {parentOr65} expressly warrant and represent that I am the parent or legal guardian of {swimmersName} on whose behalf I am completing this registration. I confirm that I have read the terms and conditions set out by The Swim Lab Pte Ltd and abide by the by-laws, including the Waiver and Release of Liability. As such, I hereby indemnify The Swim Lab Pte Ltd and its related companies from any injury and/ or loss of life during the course of the program.

Signature *
{parentguardiansName}

23

INDEMNITY FOR ADULTS
The section below to be completed by swimmers above the age of 21.

I, {swimmersName}, NRIC No. {swimmersNricpassportfin} expressly warrant and represent that I am physically fit and do not have any impairment that may make my participation unsafe for myself or others. I confirm that I have read the terms and conditions set out by The Swim Lab PTE Ltd and abide by the by-laws, including the Waiver and Release of Liability. As such, I hereby indemnify The Swim Lab PTE Ltd and its related companies from any injury and/ or loss of life during the course of the program.

Signature *
{swimmersName}

24

Electronic Signature Consent* This field is required.

By checking this box, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.