Registration Form

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Please fill in the relevant details below to complete your pregnancy profile. We will then know in advance if you or your baby have any health concerns that might need to be discussed further before commencing class. Once you have registered with Aqua4mums, you can come as often as you like until you have your baby. If you no longer want your place reserved please contact me with feedback as you wish.

You only need to fill out this form if you are signing up  for your first class with Aqua4mums. All information is kept in strictest confidence.

You can pay for classes on-line.

Your Name (required)

Your Email (required)

Your Mobile Phone Number (required)

Your Emergency Contact Number (required)

Your Date of Birth (required)

Your BABY'S Due Date (required)

Which hospital will you be attending ?

Your GP's name

Your Physio's name

Which venue will you be attending please?

Are you a happy Swimmer?

Is this your
1st baby?2nd baby?3rd baby?4th or subsequent child?

What are the ages of your other children?

What is your current occupation?

How is your general health? - Please refer to contraindications in terms and conditions

How did you hear about these classes?
Word of mouthFlyerGoogle searchTurtle TotsDiscussion forumNewspaper articleHealth professionalOther

By pressing send, I agree, for my own safety and well-being, to inform the teacher at the beginning of the class, should any changes in the above information occur, or if any medical, physical, or emotional problem arise at any time during my class attendance.

By pressing send, I acknowledge I have read the terms and conditions