Enrol Your Child In A Swimming Class

CHILDS SURNAME

CHILDS GIVEN NAME

PARENTS SURNAME

Parents Given Name

YOUR EMAIL

MOBILE

HOME PHONE

STREET

SUBURB/CITY/POSTCODE

Current level if known

CAN WE CELEBRATE YOUR CHIL'S BIRTHDAY?
NOYES

CHILDS DATE OF BIRTH

CHILDS AGE

ARE THERE ANY MEDICAL CONDITIONS OR DISABILITIES Eg Asthma Allergies

Choose School Term
Term 1Term 2Term 3Term 4

DAY PREFERRED OF SWIMMING CLASS

Please number in order of preference

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

ANYDAY

PREFERRED TIME OF SWIMMING CLASS

Please NUMBER in order of preference

ANYTIME

9:00AM

9:30AM

10:00AM

10:30AM

11:00AM

4:00PM

4:30PM

5:00PM

5:30PM

6:00PM

6:30PM

Do you give permission for Heather's Swim School to photograph your child for uses of marketing and on social media?
NOYES

I submit the above information and in doing so I agree that Heathers Swim School and its staff be released from any responsibility or liability for any accident or loss of property incurred by the applicant. I also authorise you to obtain any medical assistance that I/child may require and agree to bear any costs incurred. All information supplied remains confidential under the privacy act 2000.

Every effort will be made to meet your preferences.
PAYMENT MUST BE MADE ON ENROLEMENT.

Date

SIGNATURE