Registration Form

Registration Form

Welcome to Yarra Plenty Waves
Athlete Details
Athlete Full Name

First NameLast Name
Birth Date

DayMonthYear
Gender

MaleFemale
Squad*

Under Assessment*DevelopmentDistrictState Development 12&UState Development 13+State JuniorState SeniorTarget National AgeTarget National SeniorNational AgeNational OpenMasters (18+)FIT JnrFIT Snr
Masters

FIT MastersCompetitive
School Attending
Multi Class (Has Disability)
Coach(es) who assessed athlete?

Yu DongGabe WatsonHannah ChanMax BovalinoLucia CalderoneKris Bartlett*Unknown
Athlete Mobile
Optional for under 18 swimmers (parent mobile entered in the next section)
Athlete Email
Optional for under 18 swimmers (parent emails entered in the next section)
Account payments to be sent to*

Swimmers Email (as above)Another person is responsible for squad fees
Masters Fee Option*

10 session multipassQuaterly Fee (all sessions)
Fee Option*

10 session multipassQuaterly Fee (all sessions)
Contact Details

Responsible for account payments. Term fees invoiced per term. Sent from Yarra Swim School.
Full Name*

First NameLast Name
Postal Address*

Street Address

XX

SuburbPostcode

Post Code
Mobile*
Please enter a valid phone number
Email*
Invoices will be sent to this address
Municipality*

BanyuleNillumbikWhittleseaOther
Swimming History
How Did You Hear About Us?

Yarra Swim SchoolSocial MediaSwimming VictoriaFriends/FamilyOther
Previous Swim Club / Swim School Name
Date Started {previousSchool}

DayMonthYear
Date
Date Finished {previousSchool}

DayMonthYear
Date
Additional Notes
Privacy Statement:

The personal information contained in this document is collected to provide contact information for organisations or individuals, wishing to enrol into squad training. This information may be disclosed to other areas of Yarra Plenty Swimming Club Inc. or third parties should contact the necessary regarding an issue with the booking, and in accordance with the Information Privacy Act.
Admin Use

Medical FormSwim CentralTeam AppDry Member
Should be Empty:

Registration Form

Athlete Details

Contact Details

Swimming History

Privacy Statement: