Private Swimming Holidays Booking Form

Parent Contact Information

Child 1 Particulars

Child 1 - First Name and Surname

Child 1 - Date of Birth

Child 1 - Swimming Ability
Comfortable in the water, happy to put face under waterCan confidently and independently push off to teacherCan swim long arm paddling and independently float on backCan do overarm swimmingCan do freestyle and backstroke for 8 metresCan do freestyle, backstroke and breaststroke for 10 metresOther (specify below)

Child 1 - Preferred Day / Time for Lessons
Week 1 (June 28 / 30 / July 2 )Week 2 (July 5 / 7 / 9)

Child 2 Particulars

Child 2 - First Name and Surname

Child 2 - Date of Birth

Child 2 - Swimming Ability
Comfortable in the water, happy to put face under waterCan confidently and independently push off to teacherCan swim long arm paddling and independently float on backCan do overarm swimmingCan do freestyle and backstroke for 8 metresCan do freestyle, backstroke and breaststroke for 10 metresOther (specify below)

Child 2 - Preferred Day / Time for Lessons
Week 1 (June 28 / 30 / July 2 )Week 2 (July 5 / 7 / 9)

Child 3 Particulars

Child 3 - First Name and Surname

Child 3 - Date of Birth

Child 3 - Swimming Ability
Comfortable in the water, happy to put face under waterCan confidently and independently push off to teacherCan swim long arm paddling and independently float on backCan do overarm swimmingCan do freestyle and backstroke for 8 metresCan do freestyle, backstroke and breaststroke for 10 metresOther (specify below)

Child 3 - Preferred Day / Time for Lessons
Week 1 (June 28 / 30 / July 2 )Week 2 (July 5 / 7 / 9)

Child 4 Particulars

Child 4 - First Name and Surname

Child 4 - Date of Birth

Child 4 - Swimming Ability
Comfortable in the water, happy to put face under waterCan confidently and independently push off to teacherCan swim long arm paddling and independently float on backCan do overarm swimmingCan do freestyle and backstroke for 8 metresCan do freestyle, backstroke and breaststroke for 10 metresOther (specify below)

Child 4 - Preferred Day / Time for Lessons
Week 1 (June 28 / 30 / July 2 )Week 2 (July 5 / 7 / 9)

Additional Information

Thank you for your support of Moving Bodies Aquatics!

Book Now