SAN Child Enrolment Form (All Venues)

Child Enrolment Form
How many children do you wish to enrol?

A few more questions before we begin...
Which venue will you be attending?*
What is your preferred payment method?*
How did you hear about us?*
Who referred you? (We may have a promotion on referrals)

Parent/Guardian Details
Full Name*
First NameLast Name
Contact Number*
E-mail*
Address*
Street Address
Street Address Line 2
SuburbPost Code
StateCountry

Child #1 Details
Full Name*
First NameLast Name
Date of Birth*
DayMonthYear
Gender*
Assessed Level*
Swimming Victoria Number (if applicable)
Class Day/Time
PEGS School Student?*
Medical Conditions (all must be advised)*
Go to declarations?*

Child #2 Details
Full Name*
First NameLast Name
Date of Birth*
DayMonthYear
Gender*
Assessed Level*
Swimming Victoria Number (if applicable)
Class Day/Time
PEGS School Student?*
Medical Conditions (all must be advised)*
Go to declarations?*

Child #3 Details
Full Name*
First NameLast Name
Date of Birth*
DayMonthYear
Gender*
Assessed Level*
Swimming Victoria Number (if applicable)
Class Day/Time
PEGS School Student?*
Medical Conditions (all must be advised)*
Go to declarations?*

Child #4 Details
Full Name*
First NameLast Name
Date of Birth*
DayMonthYear
Gender*
Assessed Level*
Swimming Victoria Number (if applicable)
Class Day/Time
PEGS School Student?*
Medical Conditions (all must be advised)*
Go to declarations?*

Child #5 Details
Full Name*
First NameLast Name
Date of Birth*
DayMonthYear
Gender*
Assessed Level*
Swimming Victoria Number (if applicable)
Class Day/Time
PEGS School Student?*
Medical Conditions (all must be advised)*
Go to declarations?*

Almost done...
Media Declaration:
I, the undersigned, do hereby consent and agree that Propulsion Aquatic, PEGS Swim Academy, its employees, or agents have the right to take photographs, videotape, or digital recordings of me and my children and to use these in any and all media (including social media), now or hereafter known, and exclusively for the purpose of advertising, online photo/video galleries and training purposes.
I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to Propulsion Aquatic, PEGS Swim Academy, its agents and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies.

I waive any rights, claims or interest I may have to control the use of my identity or likeness in which media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.
Do you agree to the above media declaration?*
YesNo
Terms and Conditions of Enrolment

In General:
- Students may not be in the pool before or after their lessons.
- Refunds will not be given for mid-term cancellation of lessons (after week 2).
- Credits will not be granted for missed classes except with a medical certificate.
- Make-Up lessons, in place of a credit, are only available with a medical certificate.
Squad Swimmers (State and above):
- Parents must not be on pool deck during training (apart from the last 15 minutes of a session). At Broadmeadows, parents may wait in the foyer.
- Should there be a need for discussion, parents are to approach/request to meet a coach outside of that training session or off pool deck (i.e. in an office).
- During competitions, parents are to remain in the seating area.
- Team members may only be coaches or members of the club committee who do NOT have a child competing.
Further, I consent to my child/ren participating in the Propulsion Aquatic & PEGS Swim Academy program. I declare that the information I have provided in this enrolment form is true and correct and in connection with my children(s) participation in the Propulsion Aquatic & PEGS Swim Academy program.

I understand that while all care will be taken, I will not hold Propulsion Aquatic & PEGS Swim Academy liable for any accident, loss or injury suffered by my child during the course of their activities with Propulsion Aquatic & PEGS Swim Academy.

I authorise, where it is impractical to contact me, my child receiving, at my expense, any medical or surgical treatment or ambulance costs as may be deemed necessary. I have read and understood the terms and conditions on this enrolment form.
I agree to the above Terms & Conditions of Enrolment*
Yes
Signature
Date
DayMonthYear
Should be Empty:

Child Enrolment Form

A few more questions before we begin...

Parent/Guardian Details

Child #1 Details

Child #2 Details

Child #3 Details

Child #4 Details

Child #5 Details

Almost done...