Full Name*

Main contact number*

Other contact number

Best time to call*
MorningsAfternoonsEvenings

Your Email*

Confirm Email address*

Address 1*

Address 2

Town/City*

County*

Post Code*

A Little Bit About Your Child & Water Confidence

Childs Full Name

Childs Date of Birth / Due Date *

How confident are you in the water? 1 = not confident, 10 = very confident

12345678910

How confident is your child in the water? 1 = not confident, 10 = very confident

12345678910

Any additional information:
Please enter any child/parent medical issues we should be aware of

How did you hear about Little Dolphins?*
ParentwiseNCTsmall step magazinefamilies Hereford and Worcester magazine
FlyerWord of mouthFacebook

Do you give Little Dolphins permission to contact you via; (please select all that apply)*
PhoneTextFacebookPostEmail

Do you allow Little Dolphins to use photos of your baby/child on; (please select all that apply)*
FacebookWebsitePostersBannersLeaflets

Do you allow Little Dolphins to use videos of your baby/child on; (please select all that apply)*
FacebookWebsite

*You may opt out at a later date by contacting Little Dolphins.

Your information is NOT passed on to any 3rd party!
Little Dolphin teachers will have registers of their classes which will have your name, child’s name and your contact number incase the pool is closed.

If you have any questions please do not hesitate to contact us.