Melville Sept/Oct Holiday Swimming

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
Invalid Date of Birth for Swimmer 1

Swimmer 2

Level
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DOB
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Swimmer 3

Level
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DOB
Invalid Date of Birth for Swimmer 3

Mobile Phone(*)
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Email(*)
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Address(*)
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Post Code(*)
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Emergency Contact(*)
Please enter the name of an Emergency Contact

Phone No(*)
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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 for the selected weeks, tick the Morning option(s)
  • Then choose a preferred lesson start time below the corresponding Morning option

Week A (Tuesday 26th Sept - Friday 29th Sept)
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Start Time Preference
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Week B (Monday 2nd Oct - Friday 6th Oct)
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Start Time Preference
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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.

Credit Card #
Visa or MC ONLY
Please enter a valid Credit Card number

Expiry Date
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OR Direct Debit
Account Name
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BSB Number
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Account Number
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Amount(*)
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Terms & Conditions(*)
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