Registration Form | 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?

Yes, I am ready to enrol!

ENROL HERE!