Name child (required)

Birthday child | JJJJ-MM-DD | Example: 2005-03-25 (required)

Adress (required)

School child

Your email (required)

Name parent(s) (required)

Your telephone number (required)

I sign my child up for: A / B of ABC opleiding

A DiplomaB DiplomaABC DiplomaDolfijn Diploma

Is your child taking swimming lessons at the moment? If so,where and what is the reason for change?

Does your child has any particular 'abnormalities' that may affect the cours of the lessons?

Any other comments