Female Swimming Lesson Registration Form (PRIVATE)

* Name:

* Contact Number:

* Address1: 

   Address2:

* Postal Code:

* Email Address:

* Number Of Student:

Individual One to One - SGD240 per month 2 in a group - SGD270 per month 3 in a group - SGD300 per month 4 in a group - SGD330 per month 5 in a group - SGD360 per month 6 in a group - SGD390 per month

* Preferred Swimming Location:

* Preferred Timing:

1. First Choice: 

Select Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

2. Second Choice: 

Select Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

3. Third Choice: 

Select Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

*Student's Particulars

1. Name:

Date Of Birth:

2. Name:

Date Of Birth:

3. Name:

Date Of Birth:

4. Name:

Date Of Birth:

5. Name:

Date Of Birth:

1. Name:

Date Of Birth:

2. Name:

Date Of Birth:

3. Name:

Date Of Birth:

Remarks: