Full Name (required):

Date of Birth (dd/mm/yyyy):

Home Address:

Contact Number

• Mobile:
• Home:
• Office:

Email Address:

School currently attending (if applicable)

In the event of an emergency, please contact:

Contact Name:

Contact Number:

• Mobile:
• Home:
• Office:

Student Blood Group:

Please state any previous/current injuries/ailment/allergies/disabilities:

Swimming Particulars

Level of swimming:
BeginnerIntermediateAdvanced

Frequency of swimming:
Once a weekTwice a week

Chosen Package:
Students 24 lessonsAdultOthers

Terms & Conditions

1. Payment of fees has to be done before commencement of each swimming course.
2. No refund after the first lesson has been attended
3. Programme can be altered at any time for what ever reason as decided by EC Swim.
4. Failure to cancel a booked lesson/session within 24 hours will result in a cancellation fee or forfeiture of lesson value.
5. I understand that the Management is not responsible for any injuries or accidents that may occur to me regardless of any cause at the swimming pool or the vicinity.

I agree to the terms and conditions of EC Swim's and abide by its rules and regulations.