SWIM LIFE ACADEMY (002984488-H)

Contact Person

Name*

Salutation*

Phone*

Email*

Address*

Lesson Location*

Preferred Location*

Preferred Day(s)*

(Can select more than 1 option)

Preferred Timing(s)*

(Can select more than 1 option)

How many students are you registering for?*

1. Student Name*

Date of Birth*

Water Confident Level*

2. Student Name*

Date of Birth*

Water Confident Level*

3. Student Name*

Date of Birth*

Water Confident Level*

4. Student Name*

Date of Birth*

Water Confident Level*

5. Student Name*

Date of Birth*

Water Confident Level*

Special Remark (If Any)

Who referred Swim Life Academy to you? (If Any)

How did you know about Swim Life Academy?*

How should we follow up?*

*