EASY 2 SWIM
REGISTRATION FORM (One form per swimmer)
Surname:
_____________________________ Age
at start of course: ____________
Child’s first name:
______________________ Date
of Birth: __________________
Residential Address:
____________________ Sex:
Male / Female
____________________________________ Phone No: (H)
_________________
____________________________________
Post Code:
___________________________ Mother’s Name: ________________
Email: _______________________________
(Please try to include
this as it is the best way of keeping in contact)
INDEMNITY
TO BE SIGNED BY PARENT/LEGAL GUARDIAN:
I,
_____________________________ hereby apply to join Easy 2 Swim on behalf of the
person mentioned above. I hereby waive any claim which I may have against Easy
2 Swim, or any coach, teacher or assistant for any damage sustained by any
person resulting from participation in Easy 2 Swim activities, e.g. lessons or
functions, irrespective of whether such damages arise as a result of intent or
neglect or as a result of theft, injury or any other cause whatsoever. I also
agree to abide by the rules of Easy 2 Swim and to stay within the public areas
of the property e.g. the swimming pool, changing room and car park and not to
enter the private gardens or neighbouring areas. I also agree to remain within the changing
room or car park whilst lessons are in progress and not to be on the pool side. This waiver is unconditional and is given in
my personal capacity or as a parent or legal guardian of any minor concerned.
Signed:
_____________________________ Date:
_________________
Please note any health
or other needs on the back of this form.
Please tick the course(s) you require. I look forward to seeing you all in the near future and will contact you regarding class time. To avoid disappointment please forward your payment for the course(s) you wish to enrol for.
Autumn Term : 8 Sep - 6 Dec 2008 excluding 27 Oct-1 Nov (12 lessons, £69.00) Tick day(s)
Mon:_____ Tue: _____ Wed:
_____ Thur: _____ Fri:_____ Sat:
_____
Pupil’s Swimming
Experience. Please answer
these questions as it is vital that we teach according to the pupil’s ability
as that way they will gain the maximum from the lessons.
Is pupil new to
lessons? Y / N
Has the pupil attended
an Aquatechniques course? Y / N
Has pupil any ASA
badges? Y / N Level if Yes _________
Is pupil able to put
face in the Water? Y / N
Can pupil submerge
completely? Y / N
Can pupil swim 2-3m, 3-4m, 4-5m, 7-10m unaided and without
putting feet down?
Please return this form, with cheques payable to "Y. Knight", to Westdown Lodge, Portsmouth Road, Hindhead GU26 6BQ