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Member's online application form

Swim school branch applying for:
Member (Surname):
Member (First Name):
Nick Name:
Birth date:
Age:
Sex:
Allergies/medical conditions:
Swim Experience:
e.g. None / Water Safe
Special Considerations:

Parent1/Guardian 1/Adult Member

Preferred contact ?(Please tick):
Name & Surname:
Occupation:
E-mail:
Cell Phone:
Alternate Tel:

Parent2/Guardian 2/Adult Member

Preferred contact ?(Please tick):
Name & Surname:
Occupation:
E-mail:
Cell Phone:
Alternate Tel:

General

Name of school / Pre-primary:
Grade:
Previously attended a swim school?
Is someone from the same household currently a member?

Membership Type:
Transport required from nursery school:

Where did you hear of us?
Residential Area:  

Swimmer's Available Time & Days
Day: Mon Tues Wed Thur Fri Sat
Time:
*Note: Indicate between which hours and which days the swimmer can be scheduled, e.g. 13:00 to 17:00 or 07:30 to 10:00
Preferred Starting Date: