Parent and Baby Swimming Registration Form

Parent & Baby Swimming Registration Form

Baby / Toddler First Name

Baby / Toddler Last Name

Gender

Age

Confidence Number &

Date Of Birth

Telephone Number Daytime

Telephone Number Evening

Address

Your Email

Confirm Email

Daycare Presently Attending

Time Daycare Ends

Parents / Carers Name

Details of person or persons who will accompany baby / toddler in the pool

Any health issues for accompanying adult

Swimming Ability & Water Confidence of accompanying adult

Health issues of baby / toddler

Swimming experience & Water Confidence of baby / toddler

What Are You Hoping Your Child Will Gain From Parent and Baby 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

Any other relevant information