Enrol Today . Enrolment Form Parent or Guardian's Names* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Email* Bunya Pool Parent Assisted Water Independence Emerging Stroke Freestylers H2Go Privates (only after approval from Tanya) Not Sure Samford Pool We're up to Freestyle and Backstroke Getting onto Breaststroke and Butterfly Let's talk SQUAD Development Squad Social Squad Competition Squad Not sure, can I book a call please? Swimmers Name & DOB* Swimmers Name & DOB Swimmers Name & DOB Swimmers Name & DOB Preferred Swim Times* In case of emergency please contact (someone other than you, just in case you are the Emergency)*Include name, number and relationship to childDoctor - Practice name and number* Is there any behavioural or medical issues we should know about?*I Hereby Authorise The Obtaining Of Such Medical Assistance As Required In The Event Of Accident And Emergency* Yes No I would prefer to pay* Full term up front (you will be invoiced your term fees). If choosing this method please scroll to the end of this form and press SUBMIT) Monthly Direct Debit (you will receive forms from Payrix by text and email) Δ