Application - Garsfontein Aquatic Centre

Which Lessons are you interested in?*

Children Lessons
Baby Lessons
Private lessons / Hydro Therapy
Aqua Aerobics

Which children lessons are you interested in?*

One lesson per week (20 minutes)
Two lessons per week (4 years and older).

Which baby lessons are you interested in?*

Two lessons per week (4-24 months, Includes book)
Two lessons per week ( 2-4 years )

Which Private lessons / Hydro Therapy lessons are you interested in?*

One lesson per week (30 minutes – adults)
One lesson per week (20 minutes – kids)

Which Aqua Aerobics lessons are you interested in?*

2 lessons per week
3 lessons per week

Student Details

Name*

First Last

Age*

ID number*

Gender*

Religion

Home Address*

Postal Code*

School*

Grade*

Medical History*

Any Allergies?

Doctor name*

Doctor contact number:*

Emergency contact person*

Contact number:*

Mother/Wife Details

Name

First Last

ID number

Home Address

Postal Code

Employer

Tel Home

Tel Work

Tel Cell

Email

Father/Husband Details

Name

First Last

ID number

Home Address

Postal Code

Employer

Tel Home

Tel Work

Tel Cell

Email

Additional information the coach should be made aware of?

Application Form

Student Details

Mother/Wife Details

Father/Husband Details