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Booking Form

Please fill in the details below

    REFERENCE SUPPLIED TO YOU (required)

    PARENT / GUARDIAN FULL NAME (required)

    PARENT / GUARDIAN ADDRESS (required)

    PARENT / GUARDIAN EMAIL (required)

    PARENT / GUARDIAN PHONE (required)

    PARENT / GUARDIAN RELEVANT MEDICAL CONDITION (required)

    CHILD FULL NAME (required)

    CHILD DATE OF BIRTH (DD/MM/YYYY) (required)

    CHILD GENDER (required)

    MaleFemale

    CHILD RELEVANT MEDICAL CONDITIONS (required)

    CHILD WEIGHT (required)

    PREVIOUS SWIM EXPERIENCE IF ANY

    ANY OTHER INFORMATION (required)

    HOW DID YOU HEAR ABOUT US

    I AGREE TO AQUA BEANS TERMS AND CONDITIONS (required)

    Teaching little ones to swim the fun way.

    FIND US AT
    • Royal Leamington Spa
    • info@aquabeans.co.uk
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