Karrinyup Change to Enrolment

Surname(*)
Please enter your Surname

Parent Name(*)
Please complete the Parent Name field

Swimmer Name(s)(*)
Please type your full name.

Today's Date(*)
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Mobile Phone(*)
Please include your mobile phone number

Email(*)
Please include your email address

Suspension Information

Request for membership suspension for the following period as per Enrolment Terms and Conditions. Suspensions are only processed for 2 lessons per year, per enrolment, as per terms and conditions of enrolment.
Last Lesson I will be attending prior to suspension
(dd/mm/yyyy)
Invalid Last Lesson Date

Date to Recommence (dd/mm/yyyy)
Invalid Return to Lesson Date

  • Exact suspension dates are to be provided 14 days prior to absence from the program.
  • Enrolments will automatically recommence on reactivation date.

Cancellation of Lessons

Cancellation of enrolments must be provided with 14 days notice prior to next scheduled Direct Debit date. If cancellation is provided after this time, your next Direct Debit payment will be processed from your nominated account.
Last Lesson Date (dd/mm/yyyy)
Invalid Last Lesson Date

Reason for Cancellation
Please provide the reason for your cancellation.

Other Feedback
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Terms & Conditions(*)
Please tick to accept the terms and conditions

I confirm that the details of the above form are accurate, and as per the Kirby Swim Terms & Conditions