PARTICIPANT(S) DETAILS :
Enter up to three participants details.
First name (participant 1): *
Surname (participant 1): *
Gender (participant 1): *
Male Female
Date of birth (participant 1): *
1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of January February March April May June July August September October November December ,
First name (participant 2):
Surname (participant 2):
Gender (participant 2):
Male Female
Date of birth (participant 2):
1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of January February March April May June July August September October November December ,
First name (participant 3):
Surname (participant 3) :
Gender (participant 3):
Male Female
Date of birth (participant 3):
1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of January February March April May June July August September October November December ,
LESSON DETAILS :
Which Easyswim school are the participants enrolling in? *
Khandallah Tawa
Do you require term lessons? *
Yes No
Do you require holiday lessons? *
Yes No
Do you want to get in asap? *
Yes No
Do you want to get in for the next term? *
Yes No
PREVIOUS EXPERIENCE :
What school or kindergarten do the participants attend? (if applicable): *
Do the participants confidently put their head under water when they play in water? *
Yes No
Have the participants had swimming lessons with Easyswim before? *
Yes No
Are the participants currently enrolled in lessons elsewhere? *
Yes No
Have the participants attended swimming lessons elsewhere in the past? *
Yes No
If you answered yes for either of the previous questions, where?
Why did they stop attending? (if applicable):
PARENT/CAREGIVER DETAILS :
First name: *
Surname: *
Relationship to participant(s): *
Email address: *
Home phone: *
Work phone: *
Mobile phone: *
Street number: *
Street name: *
Suburb: *
Karori Northland Kelburn Thorndon Wilton Wadestown Crofton Downs Kaiwharawhara Ngaio Khandallah Broadmeadows Johnsonville Newlands Paparangi Woodridge Churton Park Glenside Tawa Grenada Ranui Heights Porirua East Elsdon Titahi Bay Papakowhai Paremata Plimmerton Whitby Aotea Pauatahanui Other
City: *
Post Code: *
EMERGENCY CONTACT DETAILS :
Full name of emergency contact - PLEASE NOTE - Must be different to Parent / Caregiver details: *
Relationship to participant: *
Home phone of emergency contact: *
Work phone of emergency contact: *
Mobile phone of emergency contact: *
HEALTH & SAFETY INFORMATION :
Is English the first language spoken in your home? *
Yes No
Do any of the participants have any medical conditions, physical impairments or learning disorders? *
Yes No
If yes, please elaborate:
GENERAL INFORMATION :
Any other comments you would like to add:
What made you choose Easyswim? *
If you chose Easyswim because of a friends recommendation or a referral - please add their name here:
How did you hear about Easyswim? *
School Newsletter Trailer Billborad Flier / Poster Word of Mouth Yellow / White Pages Half Way News Swimming NZ Website Radio Tawa Toy Library Plunket Babystar Other
Would you like to receive the Easyswim e-newsletter straight to your inbox? *
Yes please! No thanks
TERMS & CONDITIONS :
Payments Booking & Refund Policy:
Bookings can only be made with full payment. We do not give refunds but will credit lessons for major sickness or injury during the current term with a doctors certificate. We do not give make-up lessons for anything other than sickness/injury with a doctors certificate. No make-up lessons are given for holiday lessons.
Easyswim Swim School reserves the right to: change, postpone and or cancel classes, refuse admission of any individual, remove any individual and change class size.
Payment is required within 7 days of making booking.Late payments will incur penalties.
Health and Safety:
Participants are required to shower before entering their lesson, failing to do so will may result in refusal to enter the lesson.
Participants are required to stay out of the water for two weeks after experiencing diarrhoea/gastro symptoms.
A parent or caregiver is required to be poolside for the duration of the participant/s lesson, if a parent or caregiver is unable to do so Easyswim School Ltd reserves the right to remove participant/s from any lesson.
Easyswim Swim School Ltd accepts no responsibility for any accidents or losses incurred at any Easyswim facility or it's surrounds
Video Recording:
I hereby give my consent for the participants listed overleaf to be recorded by Easyswim School Ltd during their lesson. I also give my consent for recording of myself or other parent or caregiver poolside during the participant's lesson (persons poolside may come into shot of lesson accidentally). The recording is to be used in the making of staff training videos and for teacher assessment and feedback purposes. This footage is intended for use in training Easyswim Swim School Ltd staff members and will be used at individual and group staff training sessions. I am aware this footage will be used over an unlimited period of time and I give my consent for that.
Parking:
I am aware parking anywhere on Khandallah Primary School and Tawa School grounds before 4.30pm is prohibited
I have read the Terms & Conditions: *
Yes