Parent/guardian First Name*  

Parent/guardian Surname*  

Address 1*  

Address 2*  

Address 3  

Postcode*  

Email:*  

Contact Telephone Number*  

Alternative Telephone Number  

Swimmer's First Name*  

Swimmer's Surname*  

Date of Birth*  

Age*  

Gender*   MaleFemale

Please state any additional needs that the teacher may need to be aware of  

Note: Lessons run for 50 weeks of the year including bank holidays but excluding a 2 week Christmas break. The Pavilion operates a term time only programme.

Please select your preferred pool/s:  
 The Spa at Beckenham
 West Wickham Leisure Centre
 Walnuts Leisure Centre, Orpington
 Pavilion Leisure Centre, Bromley
 Darrick Wood Pool, Orpington

Preferred Days:  
 Mon
 Tues
 Wed
 Thur
 Fri
 Sat
 Sun

Preferred Times:  
 Morning
 Afternoon
 Evening

Please indicate swimming ability:   Please selectParent & Baby (3 to 18 months)Parent & Child (18mths to 3 years)Pre-School aged 3 to 5yrsNon Swimmer ââ‚“ aged 5 years and older Preliminary - 5+yrs, able to swim on front and backElementary - able to swim 10 metres unaidedDeep Water -able to swim 15 metres unaidedIntermediate - able to swim 25 metres unaidedAdvanced -able to swim 50 metres and aboveMile Club - able to swim 800 metres and aboveRookie Lifeguard -competent swimmer aged 8+Adult BeginnerAdult IntermediateAdult Advanced

Any other comments:  

Where did you hear about us?   Friend/family referralLeisure Centre userBritish Gas free family swim promotionLeafletWebsiteNewspaper or magazine advertPrevious userOther

If other, please specify  

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