Please complete this registration form in full. Your form will then be emailed to our office and we will be in contact to take payment and confirm dates for your swimming classes.

Please can you ensure that you adhere to the pool rules, as we are guests of the centre.

Please read these Terms and Conditions before completing the form below.

Swimmers Name *

First Name

Last Name

Date of birth *

Enter DAY, MONTH, YEAR of birth

YYYY

Email address *

Home phone number

Mobile phone number

Home postal address

Health conditions: Do you suffer from any of the following:?

Diabetes

Heart problems

Asthma

Epilepsy

Back or neck problems

Other

Level of swimmer

Describe your level of swimming and water confidence.

How did you find out about Aqua Vie

Enter the name of the parent that referred you or how you found out about us.

Do we have your permission to use photographs of you on our website and or in printed promotional material? *

Yes

I would like to receive information about adult classes & Aqua Vie news by email *

Yes

I would like to receive information about children's classes & Aqua Vie news by email *

Yes

I agree to inform the teacher of any changes or additions to the above information at the beginning of the class. *

I agree

Terms and conditions *

I have read and accept the terms and conditions

Signature *

As far as I am aware, I have disclosed to my aquatics teacher, all information regarding my health relevant to the practice of aquatics. I take full responsibility for all aquatics I may practise outside the classes now and in the future. Details on this form are entirely confidential and are for personal records only.

Today's date *

Enter DAY, MONTH, YEAR as today's date

YYYY

Additional Message

If you have any additional messages, please enter here.

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Thank you for registering for Aqua Vie Swimming