Lesson Request Form

HEROES HOUSE (Building 5, 160 Bourke Rd Alexandria NSW 2015)
Parent/Guardian Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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We only need the one name for reference purposes.

New or Past Student

New Student - Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Where would you like to swim with us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you are open to any venue, please let us know in the 'Additional Notes' section below.

VENUE SCHEDULES:
Heroes House, ALEXANDRIA
(Mon-Sat, 10am-12pm and 3pm-6pm)

Kincoppal, ROSE BAY
(Sun, 8am-12:30pm)

Souths Juniors, KINGSFORD
(Sun, 1:30pm-4:30pm)

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I'd also like to know more about: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Lesson Request Form

Lesson Request Form

HEROES HOUSE (Building 5, 160 Bourke Rd Alexandria NSW 2015)
Parent/Guardian Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you currently swimming with Little Heroes? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

New or Past Student

New Student - Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
D.O.B {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Tell us about your child {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
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Where would you like to swim with us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

VENUE SCHEDULES:
Heroes House, ALEXANDRIA
(Mon-Sat, 10am-12pm and 3pm-6pm)

Kincoppal, ROSE BAY
(Sun, 8am-12:30pm)

Souths Juniors, KINGSFORD
(Sun, 1:30pm-4:30pm)

Preferred Day 1 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Preferred Time 1 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Preferred Day 2 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Preferred Time 2 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I'd also like to know more about: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Additional Notes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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