Swim School Enrolment Form

Required fields are marked with an asterisk (*).

Participants First Name *

Participants Last Name *

Date of Birth *

Gender *

Caregivers First Name *

Caregivers Last Name *

Caregivers Contact Number *

Residential Address *

Caregivers Email Address * Providing a valid email address will enable us to contact you about booking confirmations, cancellations and any queries you may have

Medical Information

Select relevant Medical Conditions * This is necessary to ensure your/child's medical conditions are properly managed, however, no child with special needs will be excluded from participation unless on medical advice.

Convulsions/seizures (e.g. epilepsy)
Asthma/chest problems
Diabetes
Vision or Hearing problems
Ear Disorder (e.g. drainage tubes)
Dermatitis (Relevant skin conditions)
None

Other condition/s Please provide details of any further conditions you wish to share with us

Attach any Medical plans/documents (e.g. Asthma Plan)

Student Notes or Special Requirements

Parents/Caregivers participating in WONDER Classes

Parent/Caregiver Medical conditions we should be aware of This is necessary to ensure your medical conditions are properly managed and to ensure the safety of yourself and your child while attending our Wonder classes

Emergency Contact

Full Name *

Phone Contact *

Relationship *

Full Name * We require 2 Emergency contacts

Phone Contact *

Relationship *

Indemnity

I am fully aware that there may be some personal risks involved in participating in the swimming program. Being aware that there may be some risks involved in participating in the program, I take full responsibility for my decision to participate and indemnify the Roxby Downs Municipal Council and their staff from any responsibility for any injury that may occur whilst participating in this program. *

I am Fully aware of the risks involved

I have read and understood the Terms and Conditions and agree to abide by them. I believe to the best of my knowledge that the information I have provided to be accurate and correct. * Terms and Conditions are available to read on the 'Swim School' page at https://www.roxbydowns.sa.gov.au/lifestyleandsport/aquatics/swimschool

I have read and understood the Terms and Conditions and agree to abide by them. I believe to the best of my knowledge that the information I have provided in this tool to be accurate and correct.

Comments

Any additional comments?

Lifestyle & Sport

Swim School Enrolment Form

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