Swimming Lessons Sign-Up Form

Name of Parent *

First Name

Last Name

Name of Child *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Can your child swim unaided? *

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Centre *

Please select your chosen centre.

Droitwich Leisure Centre

Evesham Leisure Centre

Pershore Leisure Centre

Parent/Carer Mobile Number *

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