Registration Private Lady Swimming Lessons

Contact Person

Salutation

Name*

Phone*

Email*

Address*

What are the student's goals?

Please specify

When do you need swimming lessons?

Date

When would you like to schedule this for?

How often would you like to meet?

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

*