Children With Additional Needs Registration Form

Aquability

Empowering Swimmers. Developing Exceptional Instructors.

Please enable JavaScript in your browser to complete this form.

Child's Name *

First

Last

Gender *

Age *

Date Of Birth *

Telephone Number Daytime *

Special Of Birth

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? *

Days able to Attend *

Days & Times UNABLE To Attend: Tues to Sat, 9:00am - 5:30pm * *

Aquability Terms and Conditions Including Disclaimer * *

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

How Did You Hear About Us? *

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

Todays Date *

Map of our location

Telephone : +1 246 236 2830