Aquazone Swim Club Application Form

Full name of Swimmer *

First Name Last Name

Age and Gender Swimmer *

Age Gender

Birth Date of Swimmer *

Month Day Year

Cell Number *

Area Code Phone Number

E-mail Address *

Occupation

Family Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Landline Number

Area Code Phone Number

Emergency contact *

First Name Last Name

Emergency Contact Cell number *

Area Code Phone Number

Please list Allergies, Medication and General Health Conditions Swimmer *

Allergies, Medication and General Health Conditions of Swimmer

Medical Aid Details of Swimmer *

Name of Medical Aid, Membership Number and a Telephone Number

We have read, understood and completed this medical question. We also agree to furnish to the Swim Club any further information which we may be asked with regard to allergies, medication and general health conditions.

Medical Declaration *

We hereby sign this Medical Declaration

Date *

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I the parent / guardian, will not hold the coaches Angela Marlton, Joanne Gibson-Taylor, or any coach affiliated to the club, Curro HCA, Curro Hillcrest or any persons given charge over such child / children, responsible for any physical injuries, loss of life or loss of properties, which may be sustained beyond their control whilst my son / daughter / ward is in their care.

Furthermore, I hereby agree to the following:

Fees are invoiced monthly, payments via eft must be made within the first 5 days of receiving the invoice. Failure to do so will mean you will not be permitted to swim until fees are paid.
Please note that we have a 2 week shut down in December which is included in our pricing so no discounts or make up lessons will be provided for missed lessons during our December/January shutdown period

One full month paid notice must be given in writing should you wish to stop lessons.
Pupils inside the pool itself are the responsibility of the coaches. Pupils outside the pool are the responsibility of the parent. Please do not run around the pool area or play on the stands.
No rough play allowed in the pool area or tampering with school or club equipment. Siblings must be supervised by parents at all times.
Please be punctual when arriving for lessons and attend regularly in order to achieve maximum benefit.
Swimming lessons continue throughout school holidays, with the exception to part or all of Dec / January holidays. Closing dates vary each year and are confirmed during the 4th term.
Swimming lessons do not take place on public holidays.

Liablitiy Waiver *

We hereby sign this Liability Waiver

Date *

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Name and Surname of person responsible for the account

We hereby certify that the information given by the account holder in this application for Admission is honest, complete and accurate.

We accept liability to Aquazone Swim Club for the due and punctual payment of any once off non-refundable administration fee, swim fees and any other amounts which may become due and payable to the swim club or in respect of participation in or attendance of any extracurricular activity or Swim tours.

We accept the financial terms and conditions in this application.

Account Holder Declaration *

We hereby sign this Account Holder Declaration

Date *

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General Information

Medical Details and Declaration

Liability Waiver

Account Holder Declaration