You are here: aquaDucks »

Trial Booking

Trial Booking

The term dates for the Year 2012 are as follows:

Term 1/ 2012 2 January – 25 March 2012
Term 2/ 2012 26 March – 17 June 2012
Term 3/ 2012 18 June – 9 September 2012
Term 4/ 2012 10 September – 16 December 2012

*Term 4 is a 14-week term. Term fee will be pro-rated accordingly for a longer/shorter term or if commencing the program midway in the term.

Preferred Trial Location (required)

Child's Name (required)

Parent's Name (required)

Date Of Birth (required)

Sex (required)

Home Telephone Number (required)

Mobile Number (required)

E-Mail Address (required)

Mailing Address (required)

Medical History (If Any)

Remarks (If Any)

Please tick your preference for actual sessions
 Weekdays Weekends

Please answer the following questions (To the best of your knowledge)

Comfortable with eyes and face getting wet under the shower
 Yes No

Able to hold breath and put face in water
 Yes No

Can float/glide with face in the water
 Yes No

Can swim/glide 1- 2 metres
 Yes No

Can swim 3 – 5 metres
 Yes No

Can swim 5 metres (or more) and can lift head to breathe
 Yes No

Can swim Breaststroke and/or Freestyle 15 metres or more
 Yes No


INDEMNITY


I hereby state that I accept the fact that my child's participation in lessons conducted by Swim Centre Verhoef is entirely at his/her own risk. I hereby indemnify Swim Centre Verhoef, its management and staff against all injuries or liabilities which may arise from my child's participation.



Please tick the box if you accept the terms stated above (REQUIRED TO PROCEED WITH BOOKING SUBMISSION)






captcha

Please enter the code above