Melville April 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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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 for the selected weeks, tick the Morning option(s)
  • Then choose a preferred lesson start time below the corresponding Morning option

Week A (Mon 16th April - Friday 20th April)
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Start Time Preference
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Week B (Monday 23rd April - Fri 28th April)
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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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