Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Parent's Name *Email *How many pax are doing the Holiday Swimsafer program? *Drop down to select – $0.001 student – $330.002 students – $660.003 students – $990.004 students – $1,320.005 students – $1,650.00Prefer to do the Training and Schedule at *Delta (2,3,6,9,10,13 Dec) 8:30am to 9:45amClementi Slot are all taken up. Left Delta for you to enrol. Thanks for your support.Date of Birth #1 *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender #1 *BoyGirlTraining for Swimsafer #1 *Swimsafer Stage 1Swimsafer Stage 2Swimsafer Stage 3Swimsafer Stage 4Swimsafer Stage 5Swimsafer Stage 6No Idea. Let you assessDate of Birth #2 *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender #2 *BoyGirlTraining for Swimsafer #2 *Swimsafer Stage 1Swimsafer Stage 2Swimsafer Stage 3Swimsafer Stage 4Swimsafer Stage 5Swimsafer Stage 6No Idea. Let you assess.Date of Birth #3 *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender #3 *BoyGirlTraining for Swimsafer #3 *Swimsafer Stage 1Swimsafer Stage 2Swimsafer Stage 3Swimsafer Stage 4Swimsafer Stage 5Swimsafer Stage 6No Idea. Let you assessDate of Birth #4 *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender #4 *BoyGirlTraining for Swimsafer #4 *Swimsafer Stage 1Swimsafer Stage 2Swimsafer Stage 3Swimsafer Stage 4Swimsafer Stage 5Swimsafer Stage 6No Idea. Let you assessDate of Birth #5 *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender #5 *BoyGirlTraining for Swimsafer #5 *Swimsafer Stage 3 (9am)Swimsafer Stage 1Swimsafer Stage 1Swimsafer Stage 1Swimsafer Stage 1Swimsafer Stage 1No Idea. Let you assessTotal$0.00Please proceed to make payment (Paynow) to AQZOG Swim School at 91375141 & notify when done.Choice of PaymentCredit Card PaymentPaynow Only Save the QR Code to make payment. Save the QR Code to make payment. Save the QR Code to make payment. Save the QR Code to make payment. Save the QR Code to make payment. Math Captcha- Ensure you are Human. *What is 7+4? Submit
