Name of Applicant 1)…………...… 2)…………..... 3)………………
Age (yrs and mths) 1) …………….. 2) …………… 3) …………..…
School attending this year.................................................................................................
Name of Guardian.………………………………………………………Address.................................................................................................
Post Code………………………………….
Home ph: …………….…………………… Other…………………………………..………………………………………………
Answering service: (yes / no) Email:
Any relevant Medical Conditions………………………………………….……………………………………………………………….
……………………………………………………………………………………………………
Please Tick appropriate box below:
□ We will not be attending Swimming Lessons during Term 3 2008
□ We will be attending Swimming Lessons in Term 3 at the same time.
Same Day/Time (please state when:)…………………………………………………………………………………….
□ We will be attending Swimming Lessons in Term 3 with the following changes.

For new time choice, complete below:

DAY   Choice (1)………..…(2)………..…….(3)………………
TIME  Choice (1)………….(2)………...…....(3)………………

	ONE CHILD	TWO CHILDREN	THREE CHILDREN
Per lesson per child	$15	$14.50	$13.50
All Days - 10 lessons	$150 or $75 x 2	$290 or $145 x 2	$405 or $135 x 3

TIMES :
MONDAY – FRIDAY 4.05 – 4.35 ; 4.40 – 5.10 : 5.15 – 5.45
SATURDAY: 9.00 – 9.30 : 9.35 –10.05 : 10.10 - 1040 : 10.45 – 11.15

***ASSUME THAT YOU HAVE YOUR FIRST CHOICE, UNLESS I RING YOU***

□ Payment Enclosed $_____________ (Cheque / Money Order / Cash)
□ Pay at First Lesson
□ Pay over Internet BSB: 805023 Account: 04323096- (S A SWIM SCHOOLS)
Your Identity: W+(one child’s Surname or part & Christian Initial )e.g WRichterK
If transferring funds from your Saving and Loans, my account name is ‘k’ space ‘g’.