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Child's First Name *

Child's Last Name *

Child's Date of Birth *

Parent/Guardian's Name *

First Line of Address* *

Second Line of Address

Town *

County *

Postcode *

Contact Telephone Number *

Mobile Number (We will use this number to contact you with urgent messages, e.g. class cancellations) *

Email Address *

Emergency Contact Number (We will use this number if we cannot get hold of your mobile in an emergency) *

Child's Swimming Experience (If your child has any previous swimming experience, or anything you feel we should know about their water confidence, please let us know here)

Adult's Swimming Confidence (If you're not too water-confident yourself, no worries at all. All our Baby & Pre-School classes are at a comfortable depth for adults to stand up)

Are there any health issues we should be aware of? (Including premature birth/reflux/heart problems) *

Yes, my child has health problem(s) you need to be aware of Yes, I have a health problem you need to be aware of No health problems to bring to your attention

If yes, to any health problems (for you or your child) please provide further details here:

Where did you hear about Puddle Ducks?

Preferred class choice? *

Additional notes:

Your Data *

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(This allows us to contact you regarding your enquiry and Puddle Ducks products and services. We will never pass your data to a third party. You can choose to unsubscribe at any time either through links at the bottom of the emails we send you or by telling us over the phone or by email.)

We cannot wait to welcome you to a swimming lesson soon!

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Thank you