Please complete this form to be placed on our PARC Swim waitlist.

Question Title

* 1. Parent's full name

Question Title

* 2. Parent's phone number

Question Title

* 3. Parent's email

Question Title

* 4. If a place becomes available, we will attempt to contact you by phone. When is the best time for us to contact you by phone?

  9am - 11am 11am - 1pm 1pm - 3pm 3pm - 5pm Not available
Mon - Fri
Sat - Sun

Question Title

* 5. Children's full names

Question Title

* 6. Children's dates of birth

Question Title

* 7. Description of ability for each child

Question Title

* 8. Details of previous lessons for each child

Question Title

* 9. Are there any special needs or special requirements that we need to be aware of? Please indicate each child's name and describe their requirements.

Question Title

* 10. Do you have any other children currently enrolled in PARC Swim?

0 of 10 answered
 

T