Form Baby ´s Name * First Name Last Name Date of Birth * MM DD YYYY Child's gender * male female Parents Name * First Name Last Name Email * Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Pool Venue ? * Diplomat Hotel Dimax Hydro pool Day of the week * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you or baby have medical problems or allergies ? * I give permission for my child and me to be photographed . I understand that these photographs might be used for promoting Baby Swimsafari. * Yes No How did you hear about us ? * Website Social Media Friend recommended Flyer Other Thank you! We will get back to you soon! We look forward to see you in the pool !
