Contact details

Name

Email

Phone

Child #1

Name

Name

Student # (if known)

	Lesson Day/s
Sunday	Sunday
Monday	Monday
Tuesday	Tuesday
Wednesday	Wednesday
Thursday	Thursday
Friday	Friday
Saturday	Saturday

Class time/s

Last class date request - 14 days notice is required

Add another child?

Yes

No

Child #2

Name

Name

Student # (if known)

	Lesson Day/s
Sunday	Sunday
Monday	Monday
Tuesday	Tuesday
Wednesday	Wednesday
Thursday	Thursday
Friday	Friday
Saturday	Saturday

Class time/s

Last class date request - 30 days notice is required

Add another child?

Yes

No

Child #3

Name

Name

Student # (if known)

	Lesson Day/s
Sunday	Sunday
Monday	Monday
Tuesday	Tuesday
Wednesday	Wednesday
Thursday	Thursday
Friday	Friday
Saturday	Saturday

Class time/s

Last class date request - 30 days notice is required

Add another child?

Yes

No

Child #4

Name

Name

Student # (if known)

	Lesson Day/s
Sunday	Sunday
Monday	Monday
Tuesday	Tuesday
Wednesday	Wednesday
Thursday	Thursday
Friday	Friday
Saturday	Saturday

Class time/s

Last class date request - 30 days notice is required

Reason

Having a break

Moving out the area

Finishing lessons

Personal schedule change

Assessed level unavailable

Seasonal sports

Problem with lessons

Changing swim schools

Other

Are you keeping other children in lessons?

No

Yes