Infant Submersion Booking Form – SHRIMPS

Your Name (required)

Your Child's Name (required)

Child's Date of Birth YYYY-MM-DD(required)

Address (required)

Home phone number (required)

Mobile number (required)

Your Email (required)

I would like to book onto an Infant Submersion Shrimp class at
Malvern College Sports Complex Monday 10:00am Shrimp GemmaMalvern College Sports Complex Monday 10:30am Shrimp GemmaNew College Worcester Tuesday 11:00am HannahNew College Worcester Wednesday 1:45pm HannahRiverside Thursday 11:30am HannahAbberlery Hall School Friday 10:30am JaniceSolihull Tuesday 12:00pm Sarah (LADIES ONLY CLASS)Solihull Tuesday 12:30pm Sarah (LADIES ONLY CLASS)Kings Hawford Tuesday 1:10pm DonnaWyre Forest Leisure Centre Thursday at 12:30pm JaniceFranche Primary School Saturday 2:00pm JaniceWhitehouse Hotel Worcester Friday 9:30am DonnaWhitehouse Hotel Worcester Friday 10:00am Donna

I am happy for photographs to be taken of my child/ren for use on;
Little Dolphins website YesNo
Promotional material including adverts and banners YesNo