Course Registration Form

Swim Lesson Enrolment Form
Parent/Guardian

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail Address
example@example.com
Emergency Contact - Incase of Parent/Guardian incident, we need someone to contact other than person present at lessons

NamePhone number

Child/ren Details
CHILD 1

First NameLast Name
Age
Medical Information
Medical information that may affect your child/ren during their lessons
Swimming Abilities
Uncomfortable in water, confident putting face in and floating, 1-2 laps freestyle
CHILD 2

First NameLast Name
Age
Medical Information
Medical information that may affect your child/ren during their lessons
Swimming Abilities
Uncomfortable in water, confident putting face in and floating, 1-2 laps freestyle
CHILD 3

First NameLast Name
Age
Medical Information
Medical information that may affect your child/ren during their lessons
Swimming Abilities
Uncomfortable in water, confident putting face in and floating, 1-2 laps freestyle
CHILD 4

First NameLast Name
Age
Medical Information
Medical information that may affect your child/ren during their lessons
Swimming Abilities
Uncomfortable in water, confident putting face in and floating, 1-2 laps freestyle

Swim Lesson Enrolment Form