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Swim School Registration Form

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Swim School Registration

* = Required field

This registration is for: *

Swim School currently enrolled in (if applicable):

Individuals to register:

1 First Name*: Surname*: M/F:
  Date of birth:  Current Level*:  
2 First Name: Surname: M/F:
  Date of birth:  Current Level*:  
3 First Name: Surname: M/F:
  Date of birth:  Current Level*:  
4 First Name: Surname: M/F:
  Date of birth:  Current Level*:  

* if enrolled in a swim school

Contact Details

First name*:
(of parent, if registering children)
Surname*:
(of parent, if registering children)
Mailing Address:
Phone - home:
Phone - work:
Phone - mobile:
Email Address*:

Water Experience/Swimming Ability for children

If your children are over 3 years old, please tick which skills they are competent at for each child in the table below:

1. Submerging fully for more than 3 seconds
2. Floating on their own without equipment or help, front and back
3. Kicking on their own without equipment or help, front and back
4. Arm circles front and back
5. Bilateral breathing
6. Breast-stroke kick
7. Freestyle/backstroke distance 25m
8. Freestyle/backstroke distance 50m
9. Freestyle/backstroke distance 100m
10. Freestyle distance 200m
11. Squad level

1234567891011
Child 1
Child 2
Child 3
Child 4

Medical History

Do any of these registrants suffer from any medical conditions? (Y/N)

If yes, please specify:
Emergency Contact Person:
Emergency Contact Number:

Our after-school lessons run Monday to Friday between 3.30pm and 6.00pm and Saturday mornings between 8.30am and 12.00pm. These classes run for 25 minutes.

Our Child/Parent and pre-school lessons run Monday to Friday 9.30 am till early afternoon. Our Child/Parent classes run for 25 minutes, our pre-school classes run for 20 minutes.

Please indicate your preference for lesson times:

Due to the popularity of our swim school the above is not a confirmation of your day or time.  We will do our best to accommodate as many people as we can. We will contact you regarding availability.

Please read the following and confirm acceptance*:

Captcha (all about captcha)

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