Athlete Details
Swimmers Name
First Name
Last Name
Has {swimmersName:Firstname} previously participated in a YPW Squad trial?
Yes
No
Date of Birth:
-
Day
-
Month
Year
Date
Current Date
-
Day
-
Month
Year
Date
AGE
Other Swimming in Term 2
Learn to Swim
Swim Club
Other
Name of {currentSwimming}
Which of the following strokes can you do with competence (50m or more)
Freestyle
Backstroke
Breaststroke
Butterfly
Swimming PBs
If known
Are you able to dive from the starting block?
Yes
No
Other
What are your swimming goals?
Compete regularly in swim meets
Fitness and endurance
Technique and efficiency
Starts and turns
Confidence and comfort in the water
Competitive training methods
Open water swimming
Selection for a school team
Other
April Training Bookings
April Week 3
April Week 4
April Week 5
April Week 3 Fee
April Week 4 Fee
April Week 5 Fee
May Training Bookings
May Week 1
May Week 2
May Week 3
May Week 4
May Week 1 Fee
May Week 2 Fee
May Week 3 Fee
May Week 4 Fee
June Training Bookings
June Week 1
June Week 2
June Week 3
June Week 4
June Week 1 Fee
June Week 2 Fee
June Week 3 Fee
June Week 4 Fee
Total Amount Due
Apply Discount
Fees
Discount coupon
Swim Fun Program Fees
prev
next
( X )
AUD
Fees include a $25 Swim Fun Pack along with a $15 per session fee.
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Parent/Guardian Details
Parent/Guardian Name
First Name
Last Name
Mobile
Please enter a valid phone number.
Email
example@example.com
How did you hear about our swim club?
Submit
Should be Empty: