Swim School Student Application

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Sex (M/F)

Address

Suburb

Postcode

Emergency Contact Name

Emergency Contact Number

Term 1

Term 2

Term 3

Term 4

On behalf of the Swim School Member named above, I apply for Membership to Dedicated to Fitness Learn to Swim Program. I agree to follow the Terms and Conditions of entry to the General Gym area (details available at Reception) and in particular Swim School ( click to download ), and acknowledge I have read and understood them. I make application for the following Swim School Terms for 2014 and agree to pay in advance for the full Term detailed. I understand that any fees paid in advance are non refundable.!