CCGS Dec/Jan 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
Invalid Date of Birth for Swimmer 2

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

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 and/or Afternoon option(s)
  • Then enter a preferred lesson time below the corresponding Morning/Afternoon option

Week A (Mon 11 Dec - Fri 15 Dec) Morning Only

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Preferred start time
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Week B (Mon 18 Dec - Fri 22 Dec) Morning Only

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Preferred start time
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Week C (Wed 27 Dec - Fri 29 Dec) Morning Only

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Preferred start time
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Week D (Tue 2 Jan - Fri 5 Jan) Morning or Afternoon

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Preferred start time
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Preferred start time
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Week E (Mon 08 Jan - Fri 12 Jan) Morning or Afternoon

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Preferred start time
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Preferred start time
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Week F (Mon 15 Jan - Fri 19 Jan) Morning or Afternoon

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Preferred start time
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Preferred start time
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Week G (Mon 22 Jan - Thu 25 Jan) Afternoon Only

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Preferred start time
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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.
A 5% discount is available to current Christ Church Grammar School families.

CCGS Discount
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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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