Tuesday 10 December 2019
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Learn to Swim Enquiry
Learn to Swim Enquiry Form - Laidley
Full Name
(*)
Please let us know your name.
Email
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Childs Date of Birth
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Phone
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Address
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Enquiry
Please select...
New Enquiry
Current Member Enquiry
Feedback
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Type of Program
Please select...
Baby Classes
Learn to Swim
Adult Learn to Swim
Intensive Holiday Program
Other
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Preferred Day for Lesson
Please select...
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Intensive Holiday Program
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Has the applicant had previous swimming lessons?
Please select...
Yes
No
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If yes please describe
(*)
Please let us know your message.
What swimming strokes can the applicant do?
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How far can the applicant swim freestyle?
Please select...
5m
15m
25m +
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Age of child
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Comments
Please enter any other comments
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