DSA - Deferment Forms
Number of Student :
*
Please Select
1
2
3
Student Details
Swim Centre:
*
Please Select
DSA Bukit Jalil
DSA Setapak
DSA Kampung Pandan
DSA Shah Alam
DSA Seberang Jaya
DSA Bandar Dato' Onn
DSA Bandar Utama
DSA Bukit Kiara
DSA Setia Alam
DSA Bandar Rimbayu
Student Full Name:
*
as per MyKad / Passport / Legal Documents
Student ID:
Swim Program:
*
Please Select
Baby & Me Program
Kiddie Swimmers Program
Junior Swimmers Program
Mini Squad Program
Young Swimmers Program
Adult Swimmers Program
Private Swimming Program
Water Polo Program
Synchronized Program
DLMY x DSA Diving Program
Squad Program
Lesson Day:
*
Please Select
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Lesson Time
AM
PM
AM/PM Option
2nd Student Full Name:
*
as per MyKad / Passport / Legal Documents
2nd Student ID:
2nd Student Swim Program:
*
Please Select
Baby & Me Program
Kiddie Swimmers Program
Junior Swimmers Program
Mini Squad Program
Young Swimmers Program
Adult Swimmers Program
Private Swimming Program
Water Polo Program
Synchronized Program
DLMY x DSA Diving Program
2nd Student Lesson Day:
*
Please Select
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
2nd Student Lesson Time:
AM
PM
AM/PM Option
3rd Student Full Name:
*
as per MyKad / Passport / Legal Documents
3rd Student ID:
3rd Student Swim Program:
*
Please Select
Baby & Me Program
Kiddie Swimmers Program
Junior Swimmers Program
Mini Squad Program
Young Swimmers Program
Adult Swimmers Program
Private Swimming Program
Water Polo Program
Synchronized Program
DLMY x DSA Diving Program
3rd Student Lesson Day:
*
Please Select
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
3rd Student Lesson Time
AM
PM
AM/PM Option
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Action Requested
Student Full Name:
Effective Term:
*
Please Select
Term 1
Term 2
Term 3
Term 4
Term 5
Term 6
Term 7
Term 8
Term 9
Term 10
Term 11
Term 12
Term 13
Term 14
Term 15
Defer Start Date:
*
-
Day
-
Month
Year
Defer End Date:
*
-
Day
-
Month
Year
Reason of Deferment:
*
Please Select
Schooling
Holiday
Health Condition
Others
Remark:
*
View DSA Learn to Swim Calendar
2nd Student Full Name:
2nd Student Effective Term:
*
Please Select
Term 1
Term 2
Term 3
Term 4
Term 5
Term 6
Term 7
Term 8
Term 9
Term 10
Term 11
Term 12
Term 13
Term 14
Term 15
2nd Student Defer Start Date:
*
-
Day
-
Month
Year
2nd Student Defer End Date:
*
-
Day
-
Month
Year
2nd Student Reason of Deferment:
*
Please Select
Schooling
Holiday
Health Condition
Others
Remark:
*
3rd Student Full Name:
3rd Student Effective Term:
*
Please Select
Term 1
Term 2
Term 3
Term 4
Term 5
Term 6
Term 7
Term 8
Term 9
Term 10
Term 11
Term 12
Term 13
Term 14
Term 15
3rd Student Defer Start Date:
*
-
Day
-
Month
Year
3rd Student Defer End Date:
*
-
Day
-
Month
Year
3rd Student Reason of Leave:
*
Please Select
Schooling
Holiday
Health Condition
Others
Remark:
*
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Next
Contact Information
Contact Number:
*
-
Country Code
Phone Number
Alternate Contact Number:
-
Country Code
Phone Number
Email Address:
*
example@example.com
Current Date:
*
-
Day
-
Month
Year
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Term & Conditions
I hereby confirm that I have read and agree to the above terms and conditions. The rest of the terms and conditions of service of DSA Programs in general and/or DSA Baby & Me, Learn to Swim, Special Care Swimmer, DSA Learn to Synchro Programs DSA Little Mermaid Program and/or DSA Squad & Water Polo Programs shall be adapted and read herein.
*
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