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Redemption code :
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1
2
Participant 1
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Responsible Person First Name :
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Responsible Person Last Name :
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Mobile:
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Email Address:
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Emergency Contact Person First Name:
(Other than responsible person)
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Emergency Contact Person Last Name:
(Other than responsible person)
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Emergency Contact Person Number:
(Other than responsible person)
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Swimmer's First Name :
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Swimmer's Last Name:
Swimmer's Gender :
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Female
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Swimmer's date of birth :
Day
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Year
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Swimmer's Street Address:
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Swimmer's Suburb:
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Swimmer's Health Condition :
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Swimmer's Swimming Ability :
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Course Preference
(Can choose more than one) :
Total: 4 Lessons Consecutive
Participant 2
*
Responsible Person First Name :
*
Responsible Person Last Name :
*
Mobile:
*
Email Address:
*
Emergency Contact Person First Name:
(Other than responsible person)
*
Emergency Contact Person Last Name:
(Other than responsible person)
*
Emergency Contact Person Number:
(Other than responsible person)
*
Swimmer's First Name :
*
Swimmer's Last Name:
Swimmer's Gender :
Male
Female
*
Swimmer's date of birth :
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
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Swimmer's Street Address:
*
Swimmer's Suburb:
*
Swimmer's Health Condition :
*
Swimmer's Swimming Ability :
*
Course Preference
(Can choose more than one) :
Total: 4 Lessons Consecutive
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* Information provided must be true and correct for insurance purposes