3. Waitlist

1

Parent / Caregiver Name* This field is required.

First Name

Last Name

2

Name of Swimmer/s* This field is required.

First Name

Last Name

3

Email* This field is required.We need this to be in communication with you!

example@example.com

4

Phone Number* This field is required.Please provide best phone number for WhatsApp communication

Please enter a valid phone number.

5

Age of Swimmer* This field is required.

Beginner Baby (3 months - 12 months)

Baby (12 months - 18 months)

Beginner Toddler (18 months - 2 years)

Toddler (2 years - 3 years)

Beginner Child (3 - 4 years)

Beginner Child (4+ years)

Child (6 years +)

Beginner Adult

Competent Adult

6

Ability* This field is required.Please pick the relevant abilities of the swimmer (without a puddle jumper/floatation device)

Completely new to the water

Nervous / Apprehensive / Scared of the water (doesn't like to be in/under the water)

Happy in the water (Likes the water, can be submerged)

Wants to swim but can't (Happy to swim away from you/tried to swim alone)

Needs water safety knowledge

Competent in the water (can swim & breathe safely across a pool)

Needs stroke development (3 years +)

Has had a previous drowning / falling-in incident

7

Other InformationPlease provide any other information you would like us to know, or to enquire about. Exact age, swimming experience, detailed house locations, specific lesson enquiries, allergies etc. The more information we know, the better!

8

Lesson Type* This field is required.Please pick your desired lesson type:

Private (1 swimmer)

Semi Private (2 swimmers)

Small Group (3 swimmers)

Group Lesson (4 swimmers)

Adult Beginner Group Lesson

9

Do you have access to a pool?* This field is required.

YESNO