LLC Swim School Enrolment Form

LLC Swim Enrolment Form - Term 1 2025

P: 9797 4000 | E: llc.swimming@harvey.wa.gov.au
Disclaimer:

The Shire of Harvey will not be responsible for any injury suffered by either participant or non-participant members of the group while using facilities: whether the injury be self-inflicted, caused by another member of the group, or caused by another person not associated with the group.

The Shire of Harvey will not be liable in any way for any loss of, or damage to the property of members of the group, whether members or non-members of the group cause the loss or damage.

The above does not apply to the extent that any injury, loss or damage is caused or contributed to by the willful negligent or other unlawful act of omission of the Shire of Harvey or any of its employees, officers, agents or contractors.
Are you currently swimming in our Term 4 Program?*

YesNo
Please indicate the program you are enrolling for:*

Term 1 - Morning Infant and Preschool (4 months up to 5 years)Term 1 - Afternoon Learn to Swim (aged 5+ years)Term 1 - Squad Program (open to swimmers who have passed stage 9)Term 1 - AdultsJanuary 2025 Holiday Swim Program 1 (13 - 17 January)January 2025 Holiday Swim Program 2 (20 - 24 January)
Swimmer Details
Swimmer's Name:*

First NameLast Name
Gender:

MaleFemaleN/A
Date of Birth*

DayMonthYear
Is the swimmer currently in school full time?*

YesNoN/A (Adult)
Last Certificate Awarded:
Achieved with:
Parent/Guardian Details
Full Name:*

First NameLast Name
Phone Number (Mobile):*
Phone Number (Home):
Phone Number (Work):
Postal Address:*

Street Address

Street Address Line 2

City
Email Address:*
Secondary Contact:*

First NameLast Name
Relation to Child:*
Phone Number (Mobile):*
Special Conditions
Does your child (or parent if attending parent/baby classes) have any medical conditions/learning difficulties/social issues that may impact their learning? (If yes, we will contact you for more information)*

YesNo
Does your child (or parent if attending parent/baby classes) have any Court Orders relation to the guardianship, custody or access to those enrolling? (If yes, we will contact you for more information):*

YesNo
Do you consent to your child's photo being used in the Centre's advertising?*

YesNo
Do you consent to your child's teacher using physical contact in the instruction of your child?*

YesNo
Please indicate your preferred lesson options (eg. days, times, same time as sibling):
Important information we should consider when assigning your child to a class:
If you have applied for a Kidsport voucher, please provide the voucher code:
Terms and Conditions

Click here to view the LLC Aquatics Terms and Conditions.
I have read and agree to all policies and procedures outlined in Terms and Conditions above:*

Yes
Signature*

Clear
Date:*

MonthDayYear
Date
We are currently experiencing a high volume of enrolments.

Please allow 1 week for us to contact you regarding your enrolment.
Should be Empty:

LLC Swim Enrolment Form - Term 1 2025

Swimmer Details

Parent/Guardian Details

Special Conditions