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Child Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Date of Birth *

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Phone

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Which would you like your child to take part in? *

Sunday Lessons

Swimming Ability *

Complete beginner

Non-swimmer but water confident

Has had swim lessons before and water confident but can only swim with floats and help

Can swim independently about 5 metres without floats and help

Can swim about 15 metres front crawl and backstroke

Advanced

How did you hear about us? *

Recommendation

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Social Media

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