Child Registration Form

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Child's Name *

First

Last

Gender *

Age *

Date Of Birth (dd/mm/yyyy) *

Telephone Number Daytime *

Telephone Number Evening *

Address *

Your Email *

Email

Confirm Email

School Presently Attending *

Time School Ends *

Parents / Carers Name *

Health Issues of Child (including any disability or specific needs) *

Swimming Abiity and Water Confidence (tick all that apply) *

Any Other Information on Ability and Confidence

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

Days Your Child Would be Able to Attend Classes *

to menu Telephone

Days and Times Your Child Would be UNABLE To Attend: Tuesdays to Saturdays 9:00am - 5:30pm *

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

How Did You Hear About Us? *

I Agree To Aquability Inc. Terms & Conditions, including the disclaimer, featured on the main menu *

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

Todays Date *

Map of our location

Telephone : +1 246 236 2830