Language
English (UK)
Chinese
Student Enrolment Form
Pool Location
*
Please Select
Holland Park West (Marshall Road)
Jimboomba
Macgregor
Everton Park
Moorooka
Family Details
Parent/ Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Residential Address
*
Street Address
Street Address Line 2
City
State
Post Code
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Student Details
For Adults Learn to Swim, Masters Swim Fit and Triathlon Squad swimmers please move to the bottom of the page.
1st Student's Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Other
Medical Conditions
*
No
Yes - Please specify below
Please specify any medical conditions
Self Swimming Skill Assessment
Rows
Not Capable
Learning
Strong/ Capable
Eyes/ Face in water
Kicking
Paddles & Kicks
Freestyle Arms
15m Freestyle
Backstroke Kicking
15m Backstroke
Breaststroke Kick
25m Breaststroke
25m Butterfly
2nd Student's Name
First Name
Last Name
Student's Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Other
Medical Conditions
No
Yes - Please specify below
Please specify any medical conditions
Self Swimming Skill Assessment
Rows
Not Capable
Learning
Strong/ Capable
Eyes/ Face in water
Kicking
Paddles & Kicks
Freestyle Arms
15m Freestyle
Backstroke Kicking
15m Backstroke
Breaststroke Kick
25m Breaststroke
25m Butterfly
3rd Student's Name
First Name
Last Name
Student's Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Other
Medical Conditions
No
Yes - Please specify below
Please specify any medical conditions
Self Swimming Skill Assessment
Rows
Not Capable
Learning
Strong/ Capable
Eyes/ Face in water
Kicking
Paddles & Kicks
Freestyle Arms
15m Freestyle
Backstroke Kicking
15m Backstroke
Breaststroke Kick
25m Breaststroke
25m Butterfly
Notes
Is this enrolment for Adult learn to Swim, Masters Swim Fit & Triathlon Squads?
Please Select
Adult Learn to Swim
Masters Swim Fit
Triathlon Squads
How did you hear about us?
Please Select
Website
Social Media
School/ School newsletter
Word of Mouth
Walk In
Google/ Internet
Name of previous swim school
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