CCGS Holiday Swimming Enrolment

Enrolment Information

Surname(*)
Please enter your Surname

Parent Name(*)
Please type your full name.

Swimmer 1(*)
Please include Swimmer 1 Name

Level
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DOB (dd/mm/yyyy)
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Swimmer 2

Level
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DOB (dd/mm/yyyy)
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Swimmer 3

Level
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DOB (dd/mm/yyyy)
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Mobile Phone(*)
Please include your mobile phone number

Email(*)
Please include your email address

Address(*)
Please include your address

Post Code(*)
Please include your post code

Emergency Contact(*)
Please enter the name of an Emergency Contact

Phone No(*)
Please enter the phone number for the Emergency Contact

Medical Conditions
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Notes for Enrolment
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Holiday Lessons

Please select:

  • The week(s) you wish to swim
  • Then enter a preferred lesson start time

Week A (Tue 26th Sept - Fr 29th Sept)
9am - 11am
Prefered Start Time
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Week B (Mon 2nd Oct - Fri 6th Oct)
9am - 11am
Prefered Start Time
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Payment Details

Full payment is required to secure you place in our holiday program. Please note, we only accept Visa and MasterCard for credit card payments and your payment will not be processed until your booking is confirmed by Kirby Swim.
A 5% discount is available to current Christ Church Grammar School families.

CCGS Discount
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Credit Card #
Visa or MC ONLY(*)
Please enter a valid Credit Card number

Expiry Date(*)
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Amount(*)
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Terms & Conditions(*)
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