0645736001
AQUA 020

Adult registration form

After completing this form, you will receive a payment link for the €32.50 registration fee. Once the payment has been made, your registration will be confirmed and swimming lessons can begin.

You can indicate whether you prefer to join a mixed group or a ladies-only group.

During the swimming lessons, there is a ladies-only group in which you will be taught exclusively by women and alongside other women; no men will be present in your class. Please note that the Bijlmerbad facility does not have covered windows, so please take this into account regarding appropriate clothing.
Student’s first name Student’s last name Date of birth
You are registering for:
Adult mix - Diploma A
Ladies only - Diploma A
Adult mix - Diploma B
Ladies only - Diploma B
Adult mix - Diploma C
Ladies only - Diploma C
Lesson preference – we will take your preference into account as much as possible. Please note: lessons of 30, 40, and 60 minutes vary in price.*
18.35 - 19.15 (beginners)
18.00-18.30 (Advanced A,B,C)
18.30-19.00 (Advanced A,B,C)
18.00-19.00 (Advanced A,B,C)
Phone number Emergency contact phone number E-mail Home address
Preferred payment method
Bank transfer prior to the start of the period
Cash payment at the reception prior to the start of the period
Account number (IBAN) Account holder’s name For the safety and well-being of our members, we kindly ask whether there are any medical or physical conditions that the swimming instructor should take into account. This may include allergies, chronic conditions, or any other issues that could affect participation and/or safety.
Have you previously taken swimming lessons?
YES at KONAZ Mytylbad
YES, at another swimming school.
NO
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