EmailMe Form - Enquire Form

Form Number
Parent's Name *
First Last
Email *
Phone *
### - ### - ####
Preferred method of contact
Whatsapp
Call
Email
Text
Swimmer's Name *
First Last
Swimmer's Date of Birth *
MM / DD / YYYY
Swimmer's Ability / Experience *
Pool Access *
Private Pool
Friend's Pool
Condo Pool
No Access
Location *
Location of pool, or location of where you would like to partake in lessons.
Lesson Type *
Private
Semi-Private
Group
Other
Preferred Time (Please note that we cannot guarantee your required time and appreciate you being flexible)

Morning Midday Afternoon Evening

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday
Additional Notes
Learning disabilities, water-phobia, medical information etc