1-2-2 Swim Lesson Allocation Form - Holiday Crash Course

Please complete the application form below. Please note that this application form is for children wishing to attend 1-2-2 lessons Perth Leisure Pool swimming lessons ONLY. Once complete, the form will be sent to our swim team who will add your child onto our waiting list. In due course, our swim team will be in touch with you. If you have more than one child to add to our waiting list, a request form must be completed for each child.
Please enter a name.

Please enter the name of the child who will be attending the lesson.

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Please enter the child's Date of Birth. (DD/MM/YYYY)

Please enter a valid email address.

Please enter your email address.

Please enter a valid phone number.

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Please enter your postcode.

Please select your preferred time from the drop down menus below.


Please note that class spaces are limited and we cannot guarantee that you will receive your preferred time. We will however do our best to accommodate you request.
Please select a venue.

Please select your child's level.

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Use this space to describe your child's swimming ability.

Child's Medical Details

Please put the name of your child's doctor.

Please enter the doctors number.

This cannot be blank. If no medication is currently being taken, please put N/A

This cannot be empty. If this does not apply to your child, please put N/A.

Please select at least one session.

By selecting the above you agree to receiving communications regarding your accounts, subscriptions, and participating activities. You may receive service messages. Your data may be shared with third parties for agreed data processing such as the collection of subscription fees. Please refer to our privacy policy for more details.