Child Registration Form

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Childs First Name *

Childs Last Name *

Gender *

- You Carers

Age *

Date Of Birth *

Telephone Number Daytime *

Telephone Number Evening *

Address *

Your Email *

Email

Confirm Email

School Presently Attending

Time School Ends

Parents / Carers Name *

Health Issues *

Swimming Ability & Water Confidence *

What Are You Hoping Your Child Will Gain From Swimming Lessons *

Days & Times You Would Be UNAVAILABLE To Attend - Mon - Sat 9am - 530pm *

Do You Give Permission For Your Photos/Videos To Be Used For Promotional Purposes? *

How Did You Hear About Us? *

I Agree To Aquabilty Inc Terms & Conditions Including Disclaimer Featured On The Main Menu *

Please Enter Your Full Name As This Will Be Your Electronic Signature *

Todays Date *

Email

Map of our location

Telephone : +1 246 236 2830