Learn to Swim Profile .pdf

LEARN TO SWIM PROFILE
Please note: All information provided is kept in the strictest of confidence.
Enrolment in a class will not be confirmed until we receive this signed profile sheet
No students will be accepted into lessons if they have outstanding fees

Todays Date:
Family Details
Parents Names:



Postal Address:



Home Phone:

Mobile:

Email:



Emergency Contact:

Relation to you:

Child 1

Child 2

Child’s Surname:

Child’s Surname:

Child’s Name:

Child’s Name:

Age:

Date of Birth:

Gender: M/F

Age:

Date of Birth:

School/Day Care:

School/Day Care:

Child 3

Child 4

Child’s Surname:

Child’s Surname:

Child’s Name:

Child’s Name:

Age:

Date of Birth:

Gender: M/F

School/Day Care:

Age:

Phone:

Date of Birth:

Gender: M/F

Gender: M/F

School/Day Care:

Medical Information: (please tick)
Child 1
Asthma

Child 2

Child 3

Child 4

Medical details and emergency
contact information must be provided

ADD
Diabeties
Epilepsey

Preferred day and time for lessons
(a guide only, no guarantees)

Hearing Problems
First
Preference

Heart Complaint
Vision Problems
Allergies
Medication
Other

Second
Preference

Day
Time

Class Payment:
Upfront Payment 6 week block $70 per child | Weekly Payment $13 per child per session
• Make up lessons will only be offered if we have been notified 2 hours prior to the commencement of the lesson
• Make up lessons are subject to availability and may not be your usual day/time
• Fees are not refundable, however, each situation will be considered on a case by case basis

I/We, the undersigned have read and understand the terms and conditions of Winnows Swim Academy.
Signed:

Date: