New Enquiry Form

New Enquiry Form

Please fill out details below and submit. I will get back to you to discuss class days and times. Any immediate issues call 07494317193.
Customer Details:
Parent Name*

First NameLast Name
Child's Name*

First NameLast Name
Child's date of birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Phone Number*
E-mail
example@example.com
What days do you want to swim?*

Tuesday 4pm-6pmWednesday 4pm-6pmSaturday 9am-12pm
Current Swim Stage/Ability*

Complete beginner - no swim experienceBeginner - on noodle or armbandsSolo swimming under 5 metersSolo swimming 5-10 metersSolo swimming 10-20 metersSolo swimming 20 meters or more
Medical / Additional information - that we need to be aware of please.*
Should be Empty: