Parent / Guardian Information
Swim Lesson Registration Form
It is possible that certain groups are fully booked. In that case, you will automatically be placed on the waiting list
Name
*
First Name
Last Name
address
*
Street + house number
Street line 2
City
State
postal code
Phone
*
-
area code
Phone
E-mail
example@example.com
I am registering for swim lessons at:
*
Selecteer
Ieperman - Sat (between 9:30 AM and 12:00 PM)
Ieperman - Wed (1:00 PM to 4:00 PM)
Ieperman - Thu (4:00 PM to 6:00 PM)
Summer Course Viersel - Tue (5:00 PM to 7:00 PM)
Fibby (from 2.5 years old, info to follow)
On location
For the lessons at Ieperman, you will need to pay an entrance fee at the swimming pool itself.
Lessons
Private lessons
Group lessons
Preferences: (For example, time)
Participant Information
Name Participant
*
First Name
Last Name
Swimming experience
*
Selecteer
None
Getting accustomed to water (No or little instruction)
Comfortable in water (Lessons taken in shallow water)
Learning to survive (Lessons taken in deep water)
Edge-safe (Has learned some Freestyle)
Pool-safe (Has learned some Breaststroke)
Can swim (Can swim 25 meters or more, stroke of choice)
Snorkeling
Date of birth
*
/
Dag
/
Maand
Jaar
Datum
Additional information
Signature (parent/guardian for under 18 years old)
*
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