Swimsations Holiday Intensive Enrolment Form

Swimsations Holiday Intensive
Responsible Person Contact Details (eg Parent/Guardian)
Name (Parent/Guardian)*

First NameLast Name
DOB*

DayMonthYear
Date
Street Address*
Suburb*
State*
eg NSW
Post Code*
eg 2480
Email*
example@example.com
Phone (mobile)*
Swimming Students Details
How many swimmers are being enrolled?*

1234
Swimmer 1*
Full Name
DOB*

DayMonthYear
Date
Intensive Program*

GSAC Learn To SwimLMB Learn To SwimLMB Carnival Clinic
Sessions*

Week 1 January 6 - 10Week 2 January 13 - 17Week 3 January 20 - 24
Has your child swam with Swimsations at all in the last 10 weeks?*

YesNo
Swim Assessment Required?
Does this swimmer have any medical conditions or special needs that may affect their participation?*

YesNo
Please specify
Swimmer 2
Full Name
DOB

DayMonthYear
Date
Intensive Program

GSAC Learn To SwimLMB Learn To SwimLMB Carnival Clinic
Sessions

Week 1 January 6 - 10Week 2 January 13 - 17Week 3 January 20 - 24
Has your child swam with Swimsations at all in the last 10 weeks?

YesNo
Swim Assessment Required?
Does this swimmer have any medical conditions or special needs that may affect their participation?

YesNo
Please specify
Swimmer 3
Full Name
DOB

DayMonthYear
Date
Intensive Program

GSAC Learn To SwimLMB Learn To SwimLMB Carnival Clinic
Sessions

Week 1 January 6 - 10Week 2 January 13 - 17Week 3 January 20 - 24
Has your child swam with Swimsations at all in the last 10 weeks?

YesNo
Swim Assessment Required?
Does this swimmer have any medical conditions or special needs that may affect their participation?

YesNo
Please specify
Swimmer 4
Full Name
DOB

DayMonthYear
Date
Intensive Program

GSAC Learn To SwimLMB Learn To SwimLMB Carnival Clinic
Sessions

Week 1 January 6 - 10Week 2 January 13 - 17Week 3 January 20 - 24
Has your child swam with Swimsations at all in the last 10 weeks?

YesNo
Swim Assessment Required?
Does this swimmer have any medical conditions or special needs that may affect their participation?

YesNo
Please specify
Emergency Contact other than Responsible Person
Emergency Contact Name*

First NameLast Name
Phone (mobile)*

Swimsations Holiday Intensive

Responsible Person Contact Details (eg Parent/Guardian)

Swimming Students Details

Emergency Contact other than Responsible Person

Swimsations Terms & Conditions