Aquatics Aberdeen - Learn to Swim - Application Form

(School Age & up)

Level of Application:

Q1. Information about the Adult or Child taking the lessons

Forename Bhodhini

Surname Kumar

Date of Birth 21/05/2011

Gender Female

Q2. Does applicant have any medical conditions or special needs?

No

Q4. Customer Information (Parent / Guardian)

Title Mr

First Name Kumar

Surname Vallatharasu

Address 1 Flat 12

Address 2 Fowlershill Gardens

Address 3 Bridge of Don

Postcode AB22 8RD

Telephone Number 07894155467

Mobile Number 07894155467

Email kvakumarv@gmail.com

Location and Time / Day Choice:

Q5. School Aged Child Lessons:

Beginner

Q7. Please select all venues you'd consider for lessons:

Beach Leisure Centre

Bridge of Don Swimming Pool

 Q8. Please select all suitable days / times for lessons:

Morning Afternoon Evening

Monday X

Tuesday X

Wednesday

Thursday X

Friday X

Saturday X

Sunday X

Declaration

Q10. By ticking the following boxes and signing this agreement you warrant, declare and
acknowledge:

The information given by you in entering this agreement is correct and will be relied upon by us.

That you have read this agreement, including the terms and conditions, and that you are committing to a
minimum contract of 4 months.

This agreement will become binding upon both parties once it is countersigned.

Your direct debit collection date will be confirmed to you verbally and in writing when the membership
commences.

An initial deposit will be payable at the start of the membership. This will be a pro-rata amount to cover the
period between membership start date and the first DD collection. The deposit must be paid by debit or
credit card by telephone.

Data Protection Statement

Please tick this box to confirm that you have read the Terms & Conditions and our Privacy Policy before
signing this agreement.

Q11. Offers and Promotions

We may wish to contact you with details of our products and services. Please tick here to consent to your
personal details being added to our mailing list and be the first to hear about offers and promotions from
across Sport Aberdeen.

Q12. Agreement

Signature of Member / Parent / Guardian Kumar Vallatharasu

Date 22/08/2019

Complete Application
Q13. Please indicate what days / times are best to call you back about this enquiry:

Morning: 9am - 12 noon Lunchtime: 12 noon - 2pm Afternoon: 2pm - 5pm

Monday X

Tuesday X

Wednesday X

Thursday X

Friday X

Q14. Before you submit your application - please let us know how you heard about Sport
Aberdeen swimming lessons?

From Braehead School