Parent's Details

Guardian/parent's name in case of parent's absence

* Email

* Contact number

* FULL Address INCLUDING Postcode:

How did you hear about us?

Name of person who recommended us (if applicable)

Child's Details

Child's full name

Date of birth

DD/MM/YYYY

Stage

Venue day/time

* SEN & Medical Info

SEN: For health and safety in a group lesson water environment, children with, but not limited to, SEN and/or other conditions may require one to one lessons (we do not provide). We assess on a case by case basis if they are safe to swim in group lessons. For health and safety, must disclose Medical conditions such as asthma, epilepsy, diabetes etc.

Can your child swim without arm discs?

How many metres Can they swim?

Second child's details (if applicable)

Full name

Date of birth

DD/MM/YYYY

Stage

SEN & Medical Info

SEN: For health and safety in a group lesson water environment, children with, but not limited to, SEN and/or other conditions may require one to one lessons (we do not provide). We assess on a case by case basis if they are safe to swim in group lessons. For health and safety, must disclose Medical conditions such as asthma, epilepsy, diabetes etc.

Can your child swim without arm bands?

How many metres can they swim?

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