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Registration Form
1-to-1 swim lessons booking form
Student Name
*
*
Parent Guardian Details (if under 18)
*
*
*
Emergency Contact
*
*
*
Swimming Ability & Experience
Has The Swimmer Had Lessons Before?
*
Has The Swimmer Had Lessons Before?
Yes
No
Current Ability
*
Current Ability
Non Swimmer
Beginner
Improver
Advanced
Specific Skills
Put Face in Water
*
Put Face in Water
Yes
No
Can They Float
*
Can They Float
Yes
No
Can They Swim Unaided
*
Can They Swim Unaided
Yes
No
Goals For Lessons
*
Medical Information
Medical Conditions/Allergies/Medication/Injuries & Limitations/Additional Needs
*
Water Confidence and Logistics
Fears/Anxieties
*
Preferred Days and Times
*
Consent
Name
*
Date
*
Signature
*
Signature
Register
