Swim School June Enquiry

Please enter details below and one of our team will be in contact within 48 hours.
Please note - submission of this form does not constitute a booking.
Promotion available to new members only.

Parent/ Guardian First Name *

Parent/ Guardian Last Name *

Email Address *

Phone Number *

Address *

Street address *

City *

State *

Postcode *

Emergency Contact Name *

Emergency Contact Phone Number *

How many children do you wish to enrol? *

Child 1 First Name *

Child 1 Surname *

Child 1 Date of Birth *

Child 2 First Name *

Child 2 Surname *

Child 2 Date of Birth *

Child 3 First Name *

Child 3 Surname *

Child 3 Date of Birth *

Child 4 First Name *

Child 4 Surname *

Child 4 Date of Birth *

Are there any medical conditions we need to be aware of? If yes, please detail below:

What is your preferred location? *

Do you have an Active Kids or First Lap Voucher you would like to use? *

Please attach a copy of the voucher you wish to use

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What is your preferred method of contact? *

I agree to the CB Swim School Terms and Conditions. *

Privacy Notice

In submitting this form, you consent to Council:

1. collecting your personal information as contained in the form; and
2. using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process your application/request. You may access any of your personal information that Council holds upon request.

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Signature *

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Print Name *

Date *