Squad Enrolment Form

Please note fields marked with (*) are required.
Swimmer's Name(*)
Please include the Swimmer's Full Name.

DOB(*)
Please enter a valid date of birth for the swimmer in dd/mm/yyyy format.

Address(*)
Please include your address

Mobile Phone(*)
Please include your mobile phone number

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

Emergency Contact Phone(*)
Please enter the phone number for the Emergency Contact

Email(*)
Please include your email address

Please include a valid email address as Kirby Swim program updates are communicated via email.

Medical Conditions
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Junior Development Squad

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Blue Marlin Development

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Up to 2 CCGS pool based sessions per week

Blue Marlin Competitive

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3-8 CCGS pool based sessions per week and access to dry/gym sessions

Blue Marlin Elite

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3-8 sessions under the direct instruction from the Head Coach at Claremont and CCGS pool based sessions per week and access to dry/gym sessions

Rotto Squad

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2 pool sessions per week

Adult All-Stars

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3 pool sessions per week

Payment Details

Please note, we only accept Visa and MasterCard for direct debit payments.

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

Credit Card name(*)
Please include the name on the credit card.

Expiry Date(*)
Please enter the credit card expiry date in mm/dd.

Authorisation(*)
Please accept the Authorisation statement by checking the box.

I authorise Kirby Swim Pty Ltd to charge the amount selected fortnightly to the credit card provided.

Risk(*)
Please accept the Risk statement by checking the box.

I agree and acknowledge that I voluntarily assume all risk associated with the Kirby Swim program and hereby release and discharge Kirby Swim from all claims, suits, damages or causes of action whatsoever or howsoever arising.

Suspensions & Cancellations(*)
Please accept the Suspensions & Cancellations statement by checking the box.

The swim squads are based on a membership system, payments are processed fortnightly. To cancel or suspend your membership, Kirby Swim requires WRITTEN notification one fortnight in advance via email or letter. Suspensions can only be made for notified absences of more than 2 weeks (with the appropriate notification provided).

Missed Sessions & Holidays(*)
Please accept the Missed Sessions & Holiday statement by checking the box.

Sessions missed are not reimbursed or credited. The program runs year round, with some minor changes to training times over holiday periods.

Future Price Changes(*)
Please accept the Future Price Changes statement by checking the box.

Any future membership price changes will be made in writing to all members a month before the price change becomes effective.