Client Registration Form

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Dolphin Swim School

Email *

Client Name *

Primary Phone Number *

Home Address *

Have you had any Swim lessons before? *

Yes

If Yes, where and when did you/they take lessons *

Do you have any fear of water? *

Yes

If yes, What caused this fear? (Bad experience, Inherited, no reason) *

Do you have any medical conditions (Pregnancy Included) or are on any medication? *

Yes

Please state the medications *

Do you have any respiratory conditions that may be aggravated by swimming / water? *

Yes

Please share details *

What are your expectations at the end of your swimming lessons? *

Please select your preferred Class *

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