TRIAL AND ALA-CARTE SESSION
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Adakah anda bersetuju dengan terma dan syarat jomrenang? Sila baca sebelum mendaftar. Terima kasih. / Read TnC before Sign-Up. Rujukan/Ref. http://jomrenang.com/terms/ *
Required
Pilihan Pakej Percubaan dan Ala-Carte 
Choice of Trial and Ala-Carte Packages
*
Cadangan Tarikh/Hari/Masa untuk mulakan kelas renang./ Suggested Date / Day / Time to start swimming class. *
Nama Pelajar / Student's Name *
(For more than 1 student, Please write all students name, gender & age)
exp1: Anis/Female/27yo
exp2: Anas/Boy/4yo
No. Telefon / HP Number *
Umur pelajar/Student's Age *
Jantina/Gender *
Please inform if participants have health problems such as diabetes, high blood pressure, cancer, health rehabilitation, pregnancy, autism, skin diseases, allergies, asthma etc. Type "none" if no related. *
Penilaian Tahap Kesihatan / Health Scales *
Tidak Sihat/ Not Fit
Cukup Sihat/Fit Enough
Maklumat Ibu/Bapa Penjaga (Parents/Guardian Information)
For students under 12 years old or under guardian
Nama Ibu/Bapa/Penjaga /Parents/Guardian Name's
No telephone / HP
PERAKUAN / DECLARATION *
Required
Form submission date
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