Kids Swimming Lessons Waiting List Form
Parent Name
*
First Name
Last Name
Childs Name
*
First Name
Last Name
Childs Current Age
*
Childs Date Of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
Town / City
Region
Postal Code
Swimming Group Required
*
Level 4 - main pool - middle section - must be able to swim widths of the pool in front crawl, breaststroke and backcrawl
Level 5 - deep end - must be able to swim continously in water 2m's deep
Level 6 - lane swimming - must be able to swim out of their depth and continuous lengths of the pool
Preferred lesson day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Submit
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