Child full name*

Name of school*

Teacher's name*

Grade*

Child's birth date*

Age*

Gender*
MaleFemale

Medical condition*

Previous swimming experience*

Mother's full name*

Email address*

Cell number*

Home tel number

Address*

Father's full name*

Email address*

Cell number*

Home tel number

Address*

Additional notes

I acknowledge that I fully understand and agree to the rules, regulations and Important Notes of AquaSplash Swimmingschool. I hereby also accept Aquasplash Swimming School's indemnity agreement.*