DSA Lesson Discontinue Form

DSA - Lesson Discontinue Form
Student Particulars
Total Student(s):*

Student Particulars
Swim Centre:*
Student Full Name:*
as per MyKad / Passport / Legal Documents
Student ID:
Swim Program:*
Lesson Day:*
Lesson Time

AM/PM Option
2nd Student Full Name:*
as per MyKad / Passport / Legal Documents
2nd Student ID:
2nd Student Swim Program:*
2nd Student Lesson Day:*
2nd Student Lesson Time:

AM/PM Option
3rd Student Full Name:*
as per MyKad / Passport / Legal Documents
3rd Student ID:
3rd Student Swim Program:*
3rd Student Lesson Day:*
3rd Student Lesson Time

AM/PM Option

Action Requested
Student Full Name:
Effective Term:*
Reason of Leave:*
Comment:*
Other:*
2nd Student Full Name:
2nd Student Effective Term:*
2nd Student Reason of Leave:*
Comment:*
Other:*
3rd Student Full Name:
3rd Student Effective Term:*
3rd Student Reason of Leave:*
Comment:*
Other:*

Contact Information
Contact Number:*

Country CodePhone Number
Alternate Contact Number:

Country CodePhone Number
Email Address:*
example@example.com
Current Date:*

DayMonthYear

Term & Conditions
1) Registration fees will be collected for returning students with more than 6 TERMS BREAK.

2) Re-enrollment does not guarantee the same schedule or swim teacher.

3) Re-assessment may be required for returning students with more than 3 months break.
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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