Booking - Seahorses Swimming

Title & Full Preferred Name *

Relationship to Swimmers *

Mobile Number *

Email Address *

Home Address *

Town/Village

Postcode *

Are you happy to give consent for us to take pictures of your child's lessons to be used on our Facebook and website *

Yes

No

Only for use on website

Only for use on Facebook

Child One

Please complete this section in relation to yourself if you are booking in for adult lessons.

Type of Class *

Class Options - Pool

Child's Full Name *

Preferred Name

Pool *

Tongham

Bordon

Date of Birth *

Medical Conditions *

Has your child had lessons before?

Yes

No

Please Enter all Badges/Certificates here:

Is your child happy getting their face wet & confident in the water? *

Yes

No

Do you have a 2nd child? *

Child Two

Child's Full Name *

Swimming Ability of Adult Attending Classes

Non-Swimmer

Nervous swimmer

Confident Swimmer

Preferred Name

Date of Birth (dd/mm/yyyy) *

Medical Conditions *

Has your child had lessons before? *

Yes

No

Please Enter all Badges/Certificates here:

Is your child confident in water? *

Yes

No

Can your child swim completely unaided? *

Yes

No

Which strokes/styles can your child swim (tick all appropriate)?

“Doggy”/front paddle

Frontcrawl (overwater arm recovery)

Full frontcrawl (with side breathing)

Back kicking

Full backstroke (overwater arm recovery)

Breastroke (legs only)

Full breastroke (arms and legs)

Which strokes/styles can your child swim (tick all appropriate)?

“Doggy”/front paddle

Frontcrawl (overwater arm recovery)

Full frontcrawl (with side breathing)

Back kicking

Full backstroke (overwater arm recovery)

Breastroke (legs only)

Full breastroke (arms and legs)

Do you have a 3rd child? *

Child Three

Child's Full Name *

Preferred Name

Date of Birth (dd/mm/yyyy) *

Medical Conditions *

Has your child had lessons before?

Yes

No

Please Enter all Badges/Certificates here:

Is your child confident in water? *

Yes

No

Can your child swim completely unaided? *

Yes

No

Which strokes/styles can your child swim (tick all appropriate)?

“Doggy”/front paddle

Frontcrawl (overwater arm recovery)

Full frontcrawl (with side breathing)

Back kicking

Full backstroke (overwater arm recovery)

Breastroke (legs only)

Full breastroke (arms and legs)

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