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

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