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Booking Form
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
Mon
Tue
Wed
Thu
Fri
Sat
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