Melville Dec/Jan Holiday Swimming

Enrolment Information

Surname(*)
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Parent Name(*)
Please type your full name.

Swimmer 1(*)
Please include Swimmer 1 Name

Level
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DOB
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Swimmer 2

Level
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DOB
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Swimmer 3

Level
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DOB
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Mobile Phone(*)
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Email(*)
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Address(*)
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Post Code(*)
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Emergency Contact(*)
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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 select a preferred lesson start time below the corresponding Morning option

Week A (Mon 18 Dec - Fri 22 Dec)

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Start Time Preference
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Week B (Tue 02 Jan - Fri 05 Jan)

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Start Time Preference
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Week C (Mon 08 Jan - Fri 12 Jan)

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Start Time Preference
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Week D (Mon 15 Jan - Fri 19 Jan)

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Start Time Preference
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Week E (Mon 22 Jan - Thu 25 Jan)

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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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Amount(*)
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Terms & Conditions(*)
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