Booking – Ally Todd Swimming

Parents Name *

Contact Phone *

Email *

Address

Child 1 Name *

Child 1 Date of Birth *

Can your child 1 do any of the following?

Go right under the water?

Float on front without assistance?

Float on back without assistance?

Roll from front to back and back to front with kicking?

6 big arm circles with kicking on front and back?

Swim 15m of Freestyle and Backstroke?

Swim 30m of Freedtyle and Backstroke?

Started swimming Breaststroke and Butterfly?

Can tumble turn while swimming 100 – 200m?

Child 2 Name

Child 2 Date of Birth

Can your child 2 do any of the following?

Go right under the water?

Float on front without assistance?

Float on back without assistance?

Roll from front to back and back to front with kicking?

6 big arm circles with kicking on front and back?

Swim 15m of Freestyle and Backstroke?

Swim 30m of Freedtyle and Backstroke?

Started swimming Breaststroke and Butterfly?

Can tumble turn while swimming 100 – 200m?

Any further information you think we should know

What are you wanting to book for?

Term 1 25

Term 2 25

Term 3 25

Term 4 25

JAN ONE HP Mon 6 to Thurs 9 Jan

JAN TWO HP Mon 13 to Thurs 16 Jan

JAN THREE HP Tues 21 to Fri 24 Jan

Please indicate 3 days that are your preference for lessons

How did you hear about us?