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Swimming Lesson

Parent's Name*:

Dad Mom

Address*:

Phone Number*:

Location*:

Facebook*:

Telegram*:

School/Workplace:

Swimmer's Name*:

Emergency Contact*:

Swimmer's Gender* :

Male Female

Relationship:

Swimmer's Birthdate*:

Age:

Nationality:

Communication Language*:

Have you ever trained swimming before?:

Health Information

Others:

Have you ever drown the water?

Never

Yes

Yes, It was serious

Note :

The price above doesn’t including pool entrance fee.
Survival Swim Club reserves the right to charge swimming class from issued date, although customer doesn’t pick up the service.

We occasionally take pictures of you or your kid in action swimming Or doing other activities for our Facebook Page.

We hope to use this to keep parents and community.

Please click Yes if you WILL permission to have photographs of you or your kid taken.

Yes

How do you find us?

Banner

Flyer

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Friend

Google/Other search engine

Other

I agree to the terms & policy *