Registration for Private Swimming Lesson | Swimming Lesson in KL, PJ, Shah Alam, JB, Seremban, Penang

Contact Person

Salutation

Name*

Phone*

Email*

Address*

Tell us about your needs

Locations

What are the student's goals?

Become comfortable in water
Learn basic strokes
Improve swimming technique
Train for an event
Attain certificate
Others

Please specify

When do you need swimming lessons?

Date

When would you like to schedule this for?

How often would you like to meet?

Please specify

Where would you like to hold your lesson?

3 Preferred Timing (Weekday Only)

e.g.: Monday morning, Wednesday afternoon, Friday evening

Participant(s) Profile

How many participants are you registering for?*

Participant #1

Name

Date of Birth

Gender

Participant #2

Name

Date of Birth

Gender

Participant #3

Name

Date of Birth

Gender

Participant #4

Name

Date of Birth

Gender

Participant #5

Name

Date of Birth

Gender

Participant #6

Name

Date of Birth

Gender

Additional Info

Promotion Code (If Any)

How do you know about Swim Malaysia?

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Who recommend you about us?

Remarks

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