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Website by shopt.co.za

Learn to Swim Application Form

For non-competitive child swimmers, join us for Learn To Swim lessons.

Our lessons run on a month to month basis.
Monthly fee of R 1170,00 = 2x 25 min lessons per week

Fill in the relevant information below.

Parent Info

Parent 1 Full Name *

Parent 1 Mobile No. *

Parent 1 Email Address *

Parent 1 ID number *

Parent 1 Home Address *

Parent 2 Full Name

Parent 2 Mobile No.

Parent 2 Email Address

Parent 2 ID number

Parent 2 Home Address

Child / Student Info

Child Name *

Medical Aid Name & No. *

Doctor Name & No. *

Medical Conditions

Does your child have any of the below? Please give further detail if yes.

Allergy

Breathing disorder

Ear disorder

Epilepsy

Fainting or Dizzy spells

Give further medical detail here

Photography Consent

I give permission for my child to appear in Barracuda Aquarama photography

Indemnity

I, parent/guardian/swimmer give my consent that he/ she may participate in Learn to Swim lessons. I have submitted the medical information about the above-mentioned student/s and included details of limitations which he/she have for the activity concerned. I hereby indemnify Barracudas Swim School and all the teachers against any claim arising from loss of life, bodily injury or loss of personal items. *

Signed

Parent Name *

Date of Signature *

Upload Signature *

Uploads are stored with your submission when supported.