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
DD
MM
YYYY
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
DD
MM
YYYY
Gender
Participant #2
Name
Date of Birth
DD
MM
YYYY
Gender
Participant #3
Name
Date of Birth
DD
MM
YYYY
Gender
Participant #4
Name
Date of Birth
DD
MM
YYYY
Gender
Participant #5
Name
Date of Birth
DD
MM
YYYY
Gender
Participant #6
Name
Date of Birth
DD
MM
YYYY
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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- I have read and agreed to the terms and conditions

Contact Person