Adults Private Lessons Form

First Name

Surname

Gender

Male Female

Date of Birth

Mobile Phone Number

Emergency Contact Name

Emergency Contact Number

Disabilities (Physical or Hidden) ie: Asthma, Diabetes, Epilepsy, Heart Condition, Autism etc.. (Please enter ‘None’ if not applicable)

Level of Ability

Beginner

Non Swimmer – Fear of water – Can’t put face under water – Can’t float in horizontal position by themselves (unaided)

Intermediate

Has confidence in the water – Can float by themselves (unaided) – Can’t swim in proper stroke

Improver

Can swim front crawl or breaststroke one full length of pool (20m) – Wants to learn new stroke

Advanced

Can swim lengths comfortable but want to improve technique – To improve technique, speed, distance and resistance training

Adults Private Sessions