AQ04 Swim School Enrolment Form Enrolment Details Enrolment Type*This field is required. Select an Option Term 1 Term 2 Term 3 Term 4 January Holiday Program 1 January Holiday Program 2 October Holiday Program 1 October Holiday Program 2 January Holiday Program 1 & 2 September Holiday Program 1 & 2 Private Lesson * Required Field. Enrolment Options*This field is required. Select an Option New Student Re-enrolment * Required Field. Enrolment Year*This field is required. * Required Field. Responsible Persons Details First Name*This field is required. * Required Field. Last Name*This field is required. * Required Field. Contact Number*This field is required. * Required Field.* Please enter a valid phone number Email Address*This field is required. * Required Field.* Please enter a valid email address. Address Student 1 First Name*This field is required. * Required Field. Last Name*This field is required. * Required Field. Date of Birth*This field is required. * Required Field. Level/Class Going For Select an Option Jellyfish Guppy Seahorse Snapper Piranha Penguin Manta Ray Dolphin Walrus Orca Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Stage 8 Stage 9 Stage 10 Stage 11 Stage 12 Stage 13 Stage 14 Stage 15 Supersharks (One Day) Supersharks (Two or Three days) Adult Beginner Adult Intermediate S.N.A.P 4 Kids Gender Select an Option Male Female Unspecified 1st Preferred Class Day Select an Option Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time 2nd Preferred Class Day Select an Option Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time Medical Information or Allergies Student 2 First Name Last Name Date of Birth Gender Select an Option Male Female Unspecified Level/Class Going For Select an Option Jellyfish Guppy Seahorse Snapper Piranha Penguin Manta Ray Dolphin Walrus Orca Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Stage 8 Stage 9 Stage 10 Stage 11 Stage 12 Stage 13 Stage 14 Stage 15 Supersharks (One Day) Supersharks (Two or Three days) Adult Beginner Adult Intermediate S.N.A.P 4 Kids 1st Preferred Class Day Select an Option Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time 2nd Preferred Class Day Select an Option Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time Medical Information or Allergies Student 3 First Name Last Name Date of Birth Gender Select an Option Male Female Unspecified Level/Class Going For Select an Option Jellyfish Guppy Seahorse Snapper Piranha Penguin Manta Ray Dolphin Walrus Orca Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Stage 8 Stage 9 Stage 10 Stage 11 Stage 12 Stage 13 Stage 14 Stage 15 Supersharks (One Day) Supersharks (Two or Three days) Adult Beginner Adult Intermediate S.N.A.P 4 Kids 1st Preferred Class Day Select an Option Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time 2nd Preferred Class Day Select an Option Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time Medical Information or Allergies Terms and Conditions Swim School Terms and Conditions Swim School Terms and Conditions I have read and agreed to the Terms and Conditions linked above*This field is required. YesNo * Required Field. I agree to pay the full term fees by week 2 of the terms, unless on a documented personalised payment plan*This field is required. YesNo * Required Field. I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application*This field is required. YesNo * Required Field. The City of Greater Geraldton collects the personal information you provide in relation to the Swim School Enrolment Form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at pris@cgg.wa.gov.au. Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image Was this page helpful? How can we improve this page? Email Address*This field is required. * Required Field.* Please enter a valid Email Address Type the code from the image: Do not fill this textbox.