DSA - Squad Private Stroke Correction Form

DSA - Private Stroke Correction
Current Membership Selection:*
Training Package Duality Membership*
Training Package Junior Membership*

Student Particular
Existing Swim Center:*
Swim Club:*
Particular (1)
Student Full Name (1):*
as per MyKad / Passport / Legal Documents
Student ID (1):
for current existing registered student
Training Group(1):*
Particular (2)
Student Full Name (2):*
as per MyKad / Passport / Legal Documents
Student ID (2):
for current existing registered student
Training Group (2):*

Session Schedule
Total Session:*
Swim Center (1):*
Coach Name (1):*
Preferable Date & Time (1):*

DayMonthYear

Hour Minutes
Swim Center (2):*
Coach Name (2):*
Preferable Date & Time (2):*

DayMonthYear

Hour Minutes
Swim Center (3):*
Coach Name (3):*
Preferable Date & Time (3):*

DayMonthYear

Hour Minutes
Swim Center (4):*
Coach Name (4):*
Preferable Date & Time (4):*

DayMonthYear

Hour Minutes
Swim Center (5):*
Coach Name (5):*
DD/MM/YYY
Preferable Date & Time (5):*

DayMonthYear

Hour Minutes
Swim Center (6):*
Coach Name (6):*
Preferable Date & Time (6):*

DayMonthYear

Hour Minutes

Contact Information
Contact Number:*

Country CodePhone Number
Alternate Contact Number:

Country CodePhone Number
Email Address*
example@example.com

Term & Conditions
- Only applicable for active DSA / DSAS / DSAJ / DSAP Swimming Club members only.
- All applications will only proceed online, including payment.
- Application for Private Stroke Correction is required to apply at least 3 days prior to session commencement.
- All applications are subject to management approval.
- Applicants will be notified of their application status via email within 3 working days. Payment details will be provided upon approval.
- The application will only be considered completed after receiving the payment
- Rescheduling of session must be requested on a minimum of 24 hours before the scheduled class or the fee paid will be forfeited, unless the request is accompanied by Medical Certificate. A written letter must be given to DSA when applying for a refund based on compassionate ground (e.g. misfortune to a family member).
- Cancellation within 24 hours from the scheduled class by the student/parent/guardian is NOT ALLOWED. Fees paid will be a FORFEITED unless a Medical Certificate is provided.
I hereby confirm that I have read and agree to the above terms and conditions.
Signee Name:*
As per IC / Passport / Legal Document
Signature:*

Clear
Application Date

DayMonthYear
Date
Should be Empty: