Register

Personal information

First name*
Last name*

Address*

ZIP code*

City*

E-mailaddress (for information and zwemscore)*

Phone number

Date of birth*

Gender*
Male Female

Information activity

For which location would you like to register?*

Preffered swimming day; please choose 2 days*

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

From which time can your child participate classes? (if the lessons are for a child)*

Use of medicine or medical information that we should be aware of:

For which activity you would like to register?*

Dit is de start

Payment Method

Payment contribution en registration fee through automatic debit*
Yes, I give permission to automatic debit for the contribution and registration fee. I will give my bankaccount data below. (The contribution will not be taken until you or your child will participate the swimming classes) No, I will pay the registration fee en contribution by myself. U don’t need to fill your bankaccount information below. If you choose this, you will pay € 2,50 more extra every month.

Iban- number for automatic debit of the registration fee and contribution

The name of the person who owns the bankaccount above:

Use of E-mail address for information and zwemscore*
Yes, I give swimming school Aquayara permission to use my e-mail address for information of the swimming lessons and also to use zwemscore (the online swimming process system) No, I don’t give permission to use my e-mailaddress beside the confirmation of my registration. I do understand I can not participate to the online swimming process system.

Do you have any notes for us?

Enter security code.

By sending the form, you agree with the terms and conditions of swimming school Aquayara.