| Name and surname of child (Swimmer) |
: |
*
|
| Age |
: |
*
|
| Date of birth |
: |
*
|
| Any previous lessons |
: |
Yes No* |
| Is your child a |
: |
Beginner Intermediate Advanced Baby Swimmer* |
| Any bad experiences with water (Please elaborate) |
: |
*
|
| Parent/Guardian Details |
| Name and surname |
: |
*
|
| ID Number of parent/guardian |
: |
*
|
| Street Address |
: |
*
|
| E-mail |
: |
*
|
| Telephone Number |
: |
*
|
| Does your child have |
: |
Allergies Asthma Epilepsy Dizzy Spells Ear Problems e.g.:grommets/constant middle ear infection* |
| Other relevant information about your child |
: |
*
|