Events | funshinelearn2swim

*Parent's First Name

*Parent's Last Name

*Email

*Phone Number

Alternative Phone Number

*Street Address

*City

*State

*Country

*Postal Code

*Emergency Contact Person (in case you cannot be reached in an emergency)

*Emergency Contact Person's Phone Number

I agree to the Terms and Conditions.

Yes

No

*Where did you hear about Funshine Learn 2 Swim?

*Name (First and Last) (Child 1)

*Date of Birth (Child 1)

*Age (Child 1)

*Medical Conditions (Child 1)

Estimated Funshine Level (Child 1) (answer not required)

*How many lessons per week?

1

2

3 or more

* Name (First and Last) (Child 2)

* Date of Birth (Child 2)

* Age (Child 2)

* Medical Conditions (Child 2)

Estimated Funshine Level (Child 2) (answer not required)

* How many lessons per week?

1

2

3 or more

* Name (First and Last) (Child 3)

* Date of Birth (Child 3)

* Age (Child 3)

* Medical Conditions (Child 3)

Estimated Funshine Level (Child 3) (answer not required)

* How many lessons per week?

1

2

3 or more

* Name (First and Last) (Child 4)

* Date of Birth (Child 4)

* Age (Child 4)

* Medical Conditions (Child 4)

Estimated Funshine Level (Child 4) (answer not required)

* How many lessons per week?

1

2

3 or more

Any additional information you think we should know?

5 Chateau Ct, Petrie QLD 4502

Mob: 0433 144 764