For which activity you would like to register?*
For which location would you like to register?*
Preffered swimming day; please choose 2 days*
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:
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.
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.
Iban- number for automatic debit of the registration fee and contribution
The name of the person who owns the bankaccount above: