AYLSHAM SPORTS HUB LTD

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Swimming Lessons Enquiry Form

All personal information collected and held by Aylsham Sports Hub Limited will be stored securely and only be used for the purpose for which it is gathered. Aylsham Sports Hub Limited complies with current data protection regulations.

Email *

Childs Title: *

Childs Full Name: *

Childs Date of Birth: *

YYYY

Emergency Contact Name: *

Emergency Contact Number: *

Additional Contact Number: *

Address: *

Post Code: *

Email Address: *

Please choose Yes or No if you wish to be contacted for marketing purposes. *

Please indicate your 1st and 2nd preference on days/times for lessons below and we will do our best to accommodate this.

We currently run 30 minute group lessons Monday – Friday 3:45pm- 5:45pm (excluding Thursdays) and Weekends 8.30am - 11am.

Please tick the below options as best to describe your child's swimming ability, please tick all that applies. *

They cannot swim/are complete beginners

They do not like to put their face in the water

They can swim 5m unaided

They can swim 10m+ unaided

They will happily and confidently put their face in the water

Required

Please read the STA Learning Outcomes on the website and indicate which stage you think best fit your child's ability:

https://www.aylshamhigh.com/swimming-lessons

Stanley Beginner (3-5 years)

Stanley Advanced (3-5 years)

Octopus Beginner (6 years +)

Octopus Advanced (6 years +)

Goldfish Beginner

Goldfish Advanced

Angelfish

Shark

DECLARATION OF ANY MEDICAL CONDITIONS, Do you consider your child to have an impairment? *

If the answer to the above question is Yes, please explain further below. Please detail below any important medical information that our swim school needs to know. Such as: allergies, Medical conditions e.g. asthma, epilepsy, orthopaedic problems, injuries, or current medication.

Are there any swimming strokes or aspect of swimming that should be avoided due to conditions mentioned? Please state the reason and if doctors’ advice has been sought.

Does your child have any additional needs or are being assessed for SEN?

Please let us know below so we are aware and can better support your child with their swimming and learning.

It helps our teachers in their instruction and assessment but also from a water safety aspect.

PHOTO CONSENT

During your activity Aylsham Sports Hub (ASH) staff may take photos and videos for marketing purposes such as local media, the school website and social media. Photos and videos may also be used for our own purposes, such as displays and brochures. Child names and other personal information will never be given out or published. You may withdraw consent at any time. Images of your child held by ASH can be viewed upon request.

Having read the statement above, do you give your consent for photographs or other images to be taken, used and held for the purposes outlined above? *

Yes, I give consent for photographs or other images to be taken and used.

No, I do not give consent for photographs or other images to be taken and used.

Declaration: I confirm that the information provided is correct and I will inform a member of Aylsham Sports Hub staff if any of the information changes. By signing/ ticking this box I allow Aylsham Sports Hub to hold my information and understand that my personal information is kept safely and securely. *

I confirm

Required

Electronic signature of parent/carer: *

A copy of your responses will be emailed to the address you provided.

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