Stacey's Swim School

A. Please fill out your email details below so you can be added to our email list for stacey’s swim school

B. Please fill out your details in the enrollment form below

Enrolment & Medical Form

Parent / Guardian:(Required)

Name

Email (IF NEW FAMILY)

Mobile Phone (IF NEW FAMILY)

Child / Children's Details

Please list each child's Name & Age right now(Required)

Medical Information (for child and any parent getting in the pool with under 5’s)

Please list A. Name, B. Medical condition & C. Medication.

SELECT YOUR PREFERED DAY

MONDAY (Gabe, Jodie)

TUESDAY (Gabe morning - Dot afternoon)

SATURDAY - 4+ years only (Instructor TBA)

I give permission for this child/ children to participate in Stacey’s Swim School. If in the event of medical treatment I agree to meet all cost incurred including hospital and ambulance. I agree to the instructor administering first aid if necessary.(Required)

Yes

No

I understand that photos may be taken and uploaded to social media and used in advertising. Please specify below if you do/ do not give permission. We will not upload any media without your permission.(Required)

Yes

No

I understand that FULL PAYMENT is to be made before or on the first day. I understand my child/children cannot enter the pool without payment being made

Yes i agree

Any other requests or comments.

Please know all information given is confidential and private.

Today's Date(Required)

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