Parent Details
Full Name
First Name
Last Name
E-mail
phone
Child Details
Number of children you wish to enrol
Please Select
1
2
3
4
Child 1 Name
*
First Name
Last Name
DOB
*
Child 2 Name
First Name
Last Name
DOB
Child 3 Name
First Name
Last Name
DOB
Child 4 Name
First Name
Last Name
DOB
Class Details
What week would you like to attend?
*
Week 1: 22nd Sept - 26 Sept 2014
Week 2: 29 Sept - 3 Oct 2014
Both Week 1 & 2
What is your approximate time preference?
*
8AM - 10AM
10AM-12PM
1PM-3PM
3PM- 5:30PM
What type of class would you like to join
*
Group Class (3 to 1 )
Semi Private (2 to 1)
Private (1 to 1)
Is your child currently enrolled with AquaBuddies?
*
Yes
No - please fill out below
Other Information
How did you hear about us
Please Select
Friend
School
Elas List
Website
Other
Does your child have a medical condition
Please Select
Yes
No
If Yes, please specify
Submit
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