Child Name:


Age:


Parent Name:


Email:


Postal Address:


Phone (home):


Phone (mobile):



Which day would you prefer?
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY


What time would you prefer?
AM
PM

Is your child a current Comet/Elgin member?
YES
NO

If no, do they attend any other Swim School?
YES
NO

Which other Swim School do they attend?


ABILITY INDICATION

1. Can your child swim?
YES   NO

2. Can they put face in water?
YES    NO

3. Can they float?
YES    NO

4. Can they stroke?
YES    NO

5. Can they roll onto their side and take a breath?
YES    NO

6. Can they swim 15m?
YES    NO

7. Can they swim 30m?
YES    NO