YSS Enrolment Form

Enrolment Form
Swimmers Personal Details
Swimmer 1*

First NameLast Name
Swimmer 1 Gender*
Swimmer 1 DOB*

DayMonthYear
Date
Swimmer 2

First NameLast Name
Swimmer 2 Gender*
Swimmer 2 DOB*

DayMonthYear
Date
Swimmer 3

First NameLast Name
Swimmer 3 Gender*
Swimmer 3 DOB*

DayMonthYear
Date
Swimmer 4

First NameLast Name
Swimmer 4 Gender*
Swimmer 4 DOB *

DayMonthYear
Date
Contact Details
Parent / Guardian*

First NameLast Name
Mobile*
Please enter a valid phone number.Format: 0000 000 000.
Email*
example@example.com
Postal address*

Street

Street Address Line 2

SuburbState / Province

Postcode
Emergency Contact*

First NameLast Name
Emergency Contact Mobile*
Format: 0000 000 000.
Emergency Contact Email*
example@example.com
Swimmers Medical History

Both Child/ren & Parent/s are required for nursery classes
Does the swimmer/parent have any medical conditions that may affect their participation? Please specify
Preferred Lesson Day
First preference (select 1)*
Second preference (select 1)*
Second preference (select 1)*
Second preference (select 1)*
Second preference (select 1)*
Second preference (select 1)*
Second preference (select 1)*
Second preference (select 1)*
Should be Empty:

Enrolment Form