Children With Special Needs Registration Form

Aquability

Learn to Swim , Swimming lessons , Baby Aquatics , Aquacise

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Childs First Name *

Of Gain Issues

Childs Last Name *

Gender *

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 *

Nature Of Special Needs *

Health Issues *

Swimming Ability & Water Confidence *

What You Hoping Your Child To Gain From Swimming Lessons *

What Motivates Your Child & What Are Their Interests? *

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 *

Message

Map of our location

Telephone : +1 246 236 2830