Are You A Returning Client? Are You A Returning Client? Returning Client New Client

Full Name:

Email:

Phone Number:

Student's Full Name:

Student age and swimming experience:

Session & Time (e.g. June Session 1, 5-6pm):

Alternative Sessions (please choose two alternative times due to limited availability):

Session type (Students must be minimum 6 years of age and must be close in age & level for semi-private): Session type (Students must be minimum 6 years of age and must be close in age & level for semi-private): Private Semi-private

How did you hear about us? How did you hear about us? Facebook Posters Instagram Word of Mouth Other

Additional Information (physical/mental conditions, allergies, disabilities, etc):