Cumnor House Registration Form

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Fields marked with a * are required.

Parent's First Name *

Parent's Last Name *

Pupil's First Name *

Pupil's Last Name *

Email *

Telephone Number *

Mobile Number (please supply for emergencies)

Address 1 *

Address 2 *

Town / City *

County *

Post Code *

Pupil's Date of Birth *

Age *

Swimming Aids *

Can the pupil swim without buoyancy aids?

Badges and Certificates *

Do they hold any swimming badges or certificates

Swimming Ability *

Doctors Name *

Doctors Contact Details *

Medical Conditions *

I'm interested in a Free Trial

Pool Rules *

Please ensure you have read the pool rules that may apply.

Terms and Conditions *

Please tick that you have read and agree to the terms and conditions and have also read the pool rules that may apply.

Signature *

Fees are due at the beginning of each course to secure your place and not refundable if you do not attend the lessons.
If you have any other questions please do not hesitate to contact me on 07789552148, 01403 892542 or via the website.

What is 5 plus 2? *

Cumnor House Registration Form

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