Swim School Hold Request

Please enter details below and one of our team will be in contact soon.

Parent/ Guardian First Name *

Parent/ Guardian Last Name *

Email Address *

Phone Number *

Name of student to be placed on hold *

Child's Date of Birth *

Address *

Street address *

City *

State *

Postcode *

Reason for hold? *

If other, please list reason

Please attach Doctor's Certificate *

Browse

Duration of hold? By placing your account on hold for any duration of time, you will be charged a $15 hold fee to save your enrolment (time and day). *

Select start date for hold *

Select end date for hold *

Have you provided 2 weeks' notice before your next direct debit? *

Which CB Swim School location do you attend? *

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.

*

Signature *

Draw signature|Type signatureClear

Print Name *

Date *