Contact Details

Salutation
—Please choose an option—MrMrsMsDrProf

Your Name *

Your Contact *

Your Email *

Student Details

Student Name *

Student Gender *
—Please choose an option—FemaleMale

Student Birth Cert/NRIC/FIN no. (First Alphabet + Last 3 Digit + Last Alphabet) Eg. T626E *

Student Date of Birth. (dd/mmm/yyyy) Eg. 01 APR 2013 *

Lesson

Venue
—Please choose an option—Jurong West Swimming ComplexJurong Lake Swimming ComplexWoodlands Swimming ComplexBukit Canberra Swimming ComplexOthers (please indicate pool location at Remarks)

Preferred Day for Lesson
—Please choose an option—MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Preferred Time for Lesson

Remarks

I acknowledge that I have read the Terms and Conditions for Jurong West SRC & Jurong Garden Lake Pool
or Terms and Conditions for Woodlands Swimming Complex & Bukit Canberra Swimming Complex.

I allow Owen Swim School to send me class updates & promotions