Register your Interest for One on One Lessons

First Name *

Surname *

Postal Address *

Phone (Home) *

Phone (Mobile)

Email Address *

Please tell us when you would like your 30-minute lesson (day and time) and what you would like the instructor to concentrate on:

For Adult Lessons please stop here.

If you are registering interest for One on One Lessons for your child please provide the following details.

Child`s First Name

Child`s Surname

Date of BirthDate of Birth

Gender

Please select the term and days you are enquiring about.
One on One lessons are subject to instructor and pool space availability.

Term

Days of the week (tick all that apply)

	3.00 - 5.00 pm
Friday

Please tick any problems your child may have that could affect them during their lesson

Comments