Online Registration – Jason Swimming School

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Fields marked with an * are required

Swimmer's Full Name *

Date Of Birth *

Parent/Guardian Name *

Post Code *

Mobile *

Email *

Emergency Contact Name(Not As Above) *

Emergency Contact Number *

Current Swimming Ability (please click each title)

* Kicking

* Side-Breath

* Freestyle

* Backstroke

* Breaststroke

* Butterfly

* Club Squads

Preference 1 Class Day/Time: *

Preference 2 Class Day/Time:

Preference 3 Class Day/Time:

Please review the Swimming School policy attached BEFORE proceeding with your enrolment.

Please note: Enrolment is not confirmed until full payment is received.

For more information please email

info@jasonswimming.com