Name*

Email Address*

Phone Number*

Would you like to register a child? Would you like to register a child? Yes No

How many children would you like to register? How many children would you like to register? 1 2 3 4

Have you previously had swim lessons? Have you previously had swim lessons? Yes No

First Child Name*

First Child Date of Birth*

Has your first child previously taken swim lessons? Has your first child previously taken swim lessons? Yes No

Second Child Name*

Second Child Date of Birth*

Has your second child previously taken swim lessons? Has your second child previously taken swim lessons? Yes No

Third Child Name*

Third Child Date of Birth*

Has your third child previously taken swim lessons? Has your third child previously taken swim lessons? Yes No

Fourth Child Name*

Fourth Child Date of Birth*

Has your fourth child previously taken swim lessons? Has your fourth child previously taken swim lessons? Yes No

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