Swimming Lesson Enquiry Form
To enquire about our swimming lessons, please complete the following form. Once completed, you will then be invited to schedule a telephone call with our senior swimming instructor to discuss you enquiry.
Which of our Swimming lessons are you enquiring about ?
*
Toddler or Small Child
Junior Swimming Lesson programme
Junior Swim Club
Adult Swimming Lessons
One to One/Two Lessons
I am not sure yet
Other
How many children are you enquiring for
*
One Child
Two Children
Three Children
Four Children
Adult
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Child One Personal Information
Child One
*
Childs First Name
Childs Middle Name
Childs Last Name
Child ones Date of Birth
*
-
Month
-
Day
Year
Does the child have any medical conditions ?
*
Yes
No
Please enter any medical information below
Child One Current Swimming Ability
Please provide as much information as possible.
Does the child go swimming/visit a swimming pool regulary ?
*
Never been swimming before
Has been swimming a few times before
Infrequent swimmer/when on holiday
Frequent swimmer/pool user
When in the water is the child-
Nervous/Scared of the water
Happy
Confident
Other
When in the water, does the child-
Wear armband/floatation devices
Put their face in the water
Happily jump into the pool
Spash around happily
Wear swimming goggles
Has the child attended swimming lessons previously ?
Yes
No
N/A
Where did/do they attend lessons and what swimming stage did they reach?
Please provide us with any further information regarding the child’s swimming ability/personality which would be helpful to us
Child Two Personal Information
Child Two
*
Childs First Name
Childs Middle Name
Childs Last Name
Child Two Date of Birth
*
-
Month
-
Day
Year
Does the child have any medical conditions ?
*
Yes
No
Please enter any medical information below
Child Two Current Swimming Ability
Please provide as much information as possible.
Does the child go swimming/visit a swimming pool regulary ?
*
Never been swimming before
Has been swimming a few times before
Infrequent swimmer/when on holiday
Frequent swimmer/pool user
When in the water is the child-
Nervous/Scared of the water
Happy
Confident
Other
When in the water, does the child-
Wear armband/floatation devices
Put their face in the water
Happily jump into the pool
Spash around happily
Wear swimming goggles
Has the child attended swimming lessons previously ?
Yes
No
N/A
Where did/do they attend lessons and what swimming stage did they reach?
Please provide us with any further information regarding the child’s swimming ability/personality which would be helpful to us
Child Three Personal Information
Child Three
*
Childs First Name
Childs Middle Name
Childs Last Name
Child Three Date of Birth
*
-
Month
-
Day
Year
Does the child have any medical conditions ?
*
Yes
No
Please enter any medical information below
Child Three Current Swimming Ability
Please provide as much information as possible.
Does the child go swimming/visit a swimming pool regulary ?
*
Never been swimming before
Has been swimming a few times before
Infrequent swimmer/when on holiday
Frequent swimmer/pool user
When in the water is the child-
Nervous/Scared of the water
Happy
Confident
Other
When in the water, does the child-
Wear armband/floatation devices
Put their face in the water
Happily jump into the pool
Spash around happily
Wear swimming goggles
Has the child attended swimming lessons previously ?
Yes
No
N/A
Where did/do they attend lessons and what swimming stage did they reach?
Please provide us with any further information regarding the child’s swimming ability/personality which would be helpful to us
Child Four Personal Information
Child Four
*
Childs First Name
Childs Middle Name
Childs Last Name
Child Four Date of Birth
*
-
Month
-
Day
Year
Does the child have any medical conditions ?
*
Yes
No
Please enter any medical information below
Child Four Current Swimming Ability
Please provide as much information as possible.
Does the child go swimming/visit a swimming pool regulary ?
*
Never been swimming before
Has been swimming a few times before
Infrequent swimmer/when on holiday
Frequent swimmer/pool user
When in the water is the child-
Nervous/Scared of the water
Happy
Confident
Other
When in the water, does the child-
Wear armband/floatation devices
Put their face in the water
Happily jump into the pool
Spash around happily
Wear swimming goggles
Has the child attended swimming lessons previously ?
Yes
No
N/A
Where did/do they attend lessons and what swimming stage did they reach?
Please provide us with any further information regarding the child’s swimming ability/personality which would be helpful to us
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Please let us know how we can help you!
How can we help?
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Your Contact Details
Please provide us with your contact details
Your details
*
First Name
Last Name
Address
*
House no/name & Street
Town/City
Postcode
Email
*
example@example.com
Contact Number
*
Submit
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