Registration Private Lady Swimming Lessons

Contact Person

Salutation

Name*

Phone*

Email*

Address*

What are the student's goals?

Please specify

Where would you like to hold your lesson?

3 Preferred Timing

e.g.: Monday morning, Wednesday afternoon, Saturday evening

How many participants are you registering for?*

Participant #1

Name

Date of Birth

Participant #2

Name

Date of Birth

Participant #3

Name

Date of Birth

Participant #4

Name

Date of Birth

Participant #5

Name

Date of Birth

Participant #6

Name

Date of Birth

Promotion Code (If Any)

How do you know about Happy Fish?

Please specify

Who recommend you about us?

Remarks

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