Booking Form – Swim Clinic Ltd

Step 1 of 3

Swimmers Name *

First

Last

Gender *

Date Of Birth *//

Lessons required? *

Level Required?

Please give a brief description of your child's swimming ability. This will help us to allocate the correct class *

Health Issues

Do you have a preferred day, time and venue?

Guardians Details (for children)/Swimmers details (for adults) *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Home Phone

Mobile Phone *

Alternative Contact *

First

Last

Phone *

Can we ask where you heard about us? *

Phone