You can always press Enter⏎ to continue
Do NOT re-enroll
Fill out the form carefully to cancel registration/enrollment
START
1
Parent/Carer/Guardian/Responsible Adult Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Child's Name
*
This field is required.
First Name
Surname
Please Select
Male
Female
Please Select
Please Select
Male
Female
Gender
Please Select
Transitional
Stroke
Transitional
Please Select
Transitional
Stroke
Lesson Type
Previous
Next
Submit
Press
Enter
4
Do you have another child in the program?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
5
Child's Name
First Name
Surname
Please Select
Male
Female
Please Select
Please Select
Male
Female
Gender
Please Select
Transitional
Stroke
Transitional
Please Select
Transitional
Stroke
Lesson Type
Previous
Next
Submit
Press
Enter
6
Do you have another child in the program?
YES
NO
Previous
Next
Submit
Press
Enter
7
Child's Name
First Name
Surname
Please Select
Male
Female
Please Select
Please Select
Male
Female
Gender
Please Select
Transitional
Stroke
Transitional
Please Select
Transitional
Stroke
Lesson Type
Previous
Next
Submit
Press
Enter
8
Do you have another child in the program?
YES
NO
Previous
Next
Submit
Press
Enter
9
Child's Name
First Name
Surname
Please Select
Male
Female
Please Select
Please Select
Male
Female
Gender
Please Select
Transitional
Stroke
Transitional
Please Select
Transitional
Stroke
Lesson Type
Previous
Next
Submit
Press
Enter
10
Do you have another child in the program?
YES
NO
Previous
Next
Submit
Press
Enter
11
Child's Name
First Name
Surname
Please Select
Male
Female
Please Select
Please Select
Male
Female
Gender
Please Select
Transitional
Stroke
Transitional
Please Select
Transitional
Stroke
Lesson Type
Previous
Next
Submit
Press
Enter
12
Reason for Leaving?
*
This field is required.
You can select more then one response.
Starting Primary School
Medical Illness
Holiday
Other Sports/activities
Financial
No Suitable time available
Unhappy with progress/program
Changing swim schools
Other
Previous
Next
Submit
Press
Enter
13
If other please describe.
Previous
Next
Submit
Press
Enter
14
Thanks for you time
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
14
See All
Go Back
Submit
