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Infant Swim Survival Registration Form
Email address *
Please note there is a waiting list, you will be contacted as soon as a place becomes available.
There is a £20 non refundable registration fee that must be paid at the time of registering, this will secure your child's place for the next available start date. Registration without payment will be invalid. Please provide your child's name when making payment.

The Infant Swim Survival program is £150 (plus £20 registration fee) and consists of 5 x 10 minute lessons Monday to Friday for 4 weeks, or until all skills are achieved. Children can then move on to maintenance lessons, which are a vital part of ensuring your child's skills stay fresh and improve.

Payments can be made in installments (please provide your child's name with each installment).
Full payment must be paid prior to start date.
Please read the lesson information document below before you register.
I have read the Lesson information document *
Required
Preferred lesson time *
Required
Student Information
Full name *
Your answer
Date of birth *
Your answer
Age now *
Your answer
Medical Information
You must state any medical issues past or present.
For all medical issues a note from your child's GP/consultant will need to be provided to say that they are fit and well to take part in these lessons.
You can email it to infantswimsurvival@outlook.com. I cannot offer a place until I receive this.
Has your child ever had any medical issues? If yes please state what.
Your answer
Please state any medical treatment they have received and when.
Your answer
Are they receiving any medical treatment now? If yes please state what.
Your answer
Parent/guardian Information
Full name *
Your answer
Contact number *
Your answer
Address *
Your answer
Relationship to child *
Your answer
Would you like to be contacted via text? *
Required
Emergency contact name *
Your answer
Emergency contact number *
Your answer
Declaration
As parent/guardian of the child named above, i give permission for them to participate in Infant Swim Survival lessons *
Required
My child is in good health and physical condition and is not suffering from any condition that would prevent him/her engaging in Infant Swim Survival. *
Required
I recognize that i am responsible for my child's safety out of the water, before and after his/her lesson and will be sure to adhere to the Health and Safety Guidelines and Pool Rules. *
Required
I agree not to post any photos or videos on social media without the permission of Emma Aspinall *
Required
I give permission for photograph's and video's of my child to be used for publicity and raising awareness of drowning prevention. *
Required
Any additional information you want to state or discuss
Your answer
Signed *
Your answer
Date *
Your answer
Once you press submit you will be directed to pay the £20 registration fee to validate your registration. If this isn't paid your registration will not go through.
A copy of your responses will be emailed to the address you provided.
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