Parent's Details
Full Name
*
First Name
Last Name
Address
*
Suburb
*
State or Territory
*
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Victoria
Western Australia
Post Code
*
Phone Number
*
E-mail
*
Child's Details
Number of Children You Wish To Enrol
Please Select
1
2
3
4
5
6
7
8
Child 1 Name
*
First Name
Last Name
DOB
*
Child 2 Name
First Name
Last Name
DOB
Child 3 Name
First Name
Last Name
DOB
Child 4 Name
First Name
Last Name
DOB
Child 5 Name
First Name
Last Name
DOB
Child 6 Name
First Name
Last Name
DOB
Lesson Details
Please indicate your ideal lesson time in order of preference.
1. Day
Please Select
-Please Select-
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time
Please Select
-Please Select-
8:00am - 8:30am
8:30am - 9:00am
9:00am - 9:30am
9:30am - 10:00am
10:00am - 10:30am
10:30am - 11:00am
11:00am - 11:30am
11:30am - 12:00pm
12:00pm - 12:30pm
12:30pm - 1:00pm
1:00pm - 1:30pm
1:30pm - 2:00pm
2:00pm - 2:30pm
2:30pm - 3:00pm
3:00pm - 3:30pm
3:30pm - 4:00pm
4:00pm - 4:30pm
4:30pm - 5:00pm
5:00pm - 5:30pm
5:30pm - 6:00pm
6:00pm - 6:30pm
6:30pm - 7:00pm
2. Day
Please Select
-Please Select-
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time
Please Select
-Please Select-
8:00am - 8:30am
8:30am - 9:00am
9:00am - 9:30am
9:30am - 10:00am
10:00am - 10:30am
10:30am - 11:00am
11:00am - 11:30am
11:30am - 12:00pm
12:00pm - 12:30pm
12:30pm - 1:00pm
1:00pm - 1:30pm
1:30pm - 2:00pm
2:00pm - 2:30pm
2:30pm - 3:00pm
3:00pm - 3:30pm
3:30pm - 4:00pm
4:00pm - 4:30pm
4:30pm - 5:00pm
5:00pm - 5:30pm
5:30pm - 6:00pm
6:00pm - 6:30pm
6:30pm - 7:00pm
3. Day
Please Select
-Please Select-
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time
Please Select
-Please Select-
8:00am - 8:30am
8:30am - 9:00am
9:00am - 9:30am
9:30am - 10:00am
10:00am - 10:30am
10:30am - 11:00am
11:00am - 11:30am
11:30am - 12:00pm
12:00pm - 12:30pm
12:30pm - 1:00pm
1:00pm - 1:30pm
1:30pm - 2:00pm
2:00pm - 2:30pm
2:30pm - 3:00pm
3:00pm - 3:30pm
3:30pm - 4:00pm
4:00pm - 4:30pm
4:30pm - 5:00pm
5:00pm - 5:30pm
5:30pm - 6:00pm
6:00pm - 6:30pm
6:30pm - 7:00pm
Lesson Duration
Please Select
-Please Select-
30 mins
40 mins
60 mins (1 hour)
90 mins (1.5 hours)
Where Will The Lesson Take Place?
Please Select
-Please Select-
Same address as above
Different address
Address
Suburb
State or Territory
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Victoria
Western Australia
Post Code
When Would You Like Your Lessons To Start?
*
-
Day
-
Month
Year
Date Picker Icon
Other Information
Where Did You Hear About Us?
*
Please Select
-Please Select-
Friend
Google
Kidspot
Elas list
Flyer
Babyology
Other
Does Any Child Have a Medical Condition?
*
Please Select
-Please Select-
Yes
No
If Yes, Please Specify
Please Provide Any Details Relating To Parking
I have read and understand the AquaBuddies T&Cs
Yes
No
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