X Lab Trial Registration Form (Upated)

1
Which program are you interested in?
Learn to Swim (Kids)
Learn to Swim (Adults)
Competitive Squad
Masters
Private Classes
2
How did you hear about us?
Facebook
Instagram
Google Search
Family/Friends Referral
Brochure
3
Parent/Guardian's Name* This field is required.
First Name
Last Name
4
Parent/Guardian's NRIC/FIN/Passport * This field is required.Last 3 digits + letter (Ex. 123X)
Last 3 digits + letter (Ex. 123X)
5
Email* This field is required.Important updates will be sent to this email
Important updates will be sent to this email
6
Phone Number* This field is required.SMS updates will be sent to this number
SMS updates will be sent to this number
7
Swimmer's Name* This field is required.
First Name
Last Name
8
Swimmer's preferred name * This field is required.How would you like us to address your child
How would you like us to address your child
9
Swimmer's NRIC/Passport/FIN* This field is required.Last 3 digits + letter (Ex. 123X)
Last 3 digits + letter (Ex. 123X)
10
Swimmer's Gender* This field is required.
Male
Female
11
Swimmer's Date of Birth * This field is required.
Month
Day
Year
12
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
13
Emergency Contact Name* This field is required.
First Name
Last Name
14
Emergency Contact Number* This field is required.
Please enter a valid phone number.
15
Does he/she have any swimming experience? If any, please specify what strokes he/she is able to do.* This field is required.
16
Do you have any swimming experience? If any, please specify.
17
Private Session

Please email us at swim@xlab.com.sg, or you can give us a call at, 9664 1955 to book a private session.

You may also click her to message us via WhatsApp
18
Terms and Conditions (Please Read)* This field is required.
19
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 X Lab Pro Pte Ltd and abide by the by-laws, including the Waiver and Release of Liability. As such, I hereby indemnify X Lab Pro PTE Ltd and its related companies from any injury and/ or loss of life during the course of the program.

Signature *
20
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 X Lab Pro PTE Ltd and abide by the by-laws, including the Waiver and Release of Liability. As such, I hereby indemnify X Lab Pro Pte Ltd and its related companies from any injury and/ or loss of life during the course of the program.
Signature *
21
Electronic Signature Consent* This field is required.
By checking here, 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.
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