New Customer Registration Form
Customer Details:
Parent's Name
*
First Name
Last Name
Children's Names & Ages
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Address (Where Lessons Will Be Held)
*
Interested in Privates or Group Lessons?
*
Privates
Group Lessons
Both
Preferred Days & Times
*
When would you like to start?
*
How many sessions per week?
*
Do you have access to your own pool or do you need us to provide a pool location for you?
*
Anything else we should know?
How did you hear about us?
*
Please Select
Referral
Google
Social Media
Flyer or Business Card
Other
Will you be willing to recommend us? We love giving referral deals!
Yes
No
In Future
Please give reference of any two people whom you feel would be interested:
Full Name
Contact Number
1
2
3
Submit
Should be Empty: