Swim Lesson Interest Form
Thank you for your enquiry with S.W.I.M Movement. All our S.W.I.M Educators are qualified and licensed swimming instructors with valid CPR and life safety skills.

Kindly fill up this interest form and we will get back to you.

Please note that we require consent from parents or guardians for learners under the age of 18.
Sign in to Google to save your progress. Learn more
Name of Swimmer *
A separate form is required if there is more than 1 interested learner.
Name of Parents/Guardians *
Gender of Swimmer *
Date of Birth of Swimmer *
MM
/
DD
/
YYYY
Contact number of Swimmer or Parents/Guardians *
Email address of Swimmer or Parents/Guardians *
Preferred Days *
You may indicate up to 3 preferred day and we will try to accommodate based on Teachers' availability
Required
Preferred Sessions *
You may indicate up to 3 preferred session and we will try to accommodate based on Teachers' availability
Required
Medical or Special Condition (if any)
The information provided here is important for our S.W.I.M Educators to take note of and plan the lesson accordingly for the learners.
Swim Pool Location Preference *
Required
If you have picked "own residential swim pool facility" in your last answer, please let us know where :)
Swimmer's abilities and experience *
Required
How did you hear about us?  *
Required
If you have picked "Friends" in your last answer, let us know who they are! :) *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms