Make a request to register your child for swim school lessons for next term

Holiday Programme Booking Request

* = Required field

Have any of your children had swimming classes here previously?*

If yes, have any of your details or your children's details changed?

Swim School currently enrolled in (if applicable):

Individuals to request a booking for:

Register up to four, information for first child is required, date of birth is required for each child please.

Child1: (required)

First Name: Surname:
Date of Birth: Current level if known:
Sex:
Any medical or cultural information it would be beneficial for us to know

Child2:

First Name: Surname:
Date of Birth: Current level if known:
Sex:
Any medical or cultural information it would be beneficial for us to know

Child3:

First Name: Surname:
Date of Birth: Current level if known:
Sex:
Any medical or cultural information it would be beneficial for us to know

Child4:

First Name: Surname:
Date of Birth: Current level if known:
Sex:
Any medical or cultural information it would be beneficial for us to know

Contact Details:

First name*:
(of parent, if registering children)
Surname*:
(of parent, if registering children)
Mailing Address:
Phone - home:
Phone - mobile*:
Email Address*:

Water Experience/Swimming Ability for children:

Fill this out if you are unsure of your child’s level. If your children are over 3 years old, please tick which skills they are competent at for each child in the table below:

1. Submerging fully for more than 3 seconds
2. Floating on their own without equipment or help, front and back
3. Kicking on their own without equipment or help, front and back
4. Arm circles front and back
5. Breathing every three strokes on the side
6. Breast-stroke kick
7. Freestyle/backstroke distance 25m
8. Freestyle/backstroke distance 50m
9. Freestyle/backstroke distance 100m
10. Freestyle distance 200m

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Child 1
Child 2
Child 3
Child 4

Please indicate if you have a preference for lesson times or days:

The above is not a confirmation of your day or time. We will contact you with exactly what we have available and you will be able to choose a time..

Please read the following and confirm acceptance*: