*Applicants Name 1*D.O.B.(m/d/y)*Last Completed Level Instructor Request
Applicants Name 2
D.O.B.(m/d/y) Last Completed LevelInstructor Request
Applicants Name 3
D.O.B.(m/d/y)
Last Completed Level
Instructor Request
Applicants Name 4
D.O.B.(m/d/y)
Last Completed Level
Instructor Request
Allergies 1
Allergies 2
Allergies 3
Allergies 4
Does the applicant require an EPI pen?
Choice #1 *For CRASH COURSES please put the course of interest in fields below*
*Day
*Time
Special Note
Choice #2
Day
Time
Special Note
*Method of Payment
- A $100.00 non-refundable deposit is required per student for any 8 week session classes.
- A $100.00 non-refundable deposit is required per course for all crash courses.
All deposit cheques need to be received 48 hours
after confirmation.
Please make your cheque payable to:
Aqua Kids Swim School
35 Point O" Woods Drive, Concord, Ontario L4K 2E1
Tel: 905-886-2322
Toll Free: 1-866-886-2322
Fax: 905-738-3616
Email:
aquakids@rogers.com
I hereby release Aqua Kids Swim School, their staff and the swimming pool owner and staff from all claims
for damages arising from and/or associated with any accident or injury which occurs or arises thereafter to
the applicant named heron or to any spectator, guardian, or parent of the applicant during the swim program
at any location.
AquaKids will contact you by email within 48 hours to confirm your registration.