Swim Lesson Enrolment Form

Fields marked with an asterisk (*) must be completed

Aquatic Centre	Bairnsdale Lakes Entrance Orbost
Type of Enrolment	New Enrolment Re-enrolment Direct Debit Enrolment Term Enrolment Holiday Intensive Swim Program
Responsible Person Details
Name * (required)
Email address * (required)
Postal address * (required)
Phone Number
Home
Work
Mobile
Fax
Emergency Contact Details
Emergency contact name * (required)
Relationship * (required)
Home phone number
Mobile phone number * (required)
Student Details
Student 1 name
Student 1 date of birthStudent 1 date of birth	RadDatePicker RadDatePicker Open the calendar popup. Calendar Title and navigation Title and navigation << < January 2021 > << January 2021   M T W T F S S 53 28 29 30 31 1 2 3 2 4 5 6 7 8 9 10 3 11 12 13 14 15 16 17 4 18 19 20 21 22 23 24 5 25 26 27 28 29 30 31 6 1 2 3 4 5 6 7
Student 1 age
Student 1 gender	Male Female
Student 1 - any medical conditions
Student 2 name
Student 2 date of birthStudent 2 date of birth	RadDatePicker RadDatePicker Open the calendar popup. Calendar Title and navigation Title and navigation << < January 2021 > << January 2021   M T W T F S S 53 28 29 30 31 1 2 3 2 4 5 6 7 8 9 10 3 11 12 13 14 15 16 17 4 18 19 20 21 22 23 24 5 25 26 27 28 29 30 31 6 1 2 3 4 5 6 7
Student 2 age
Student 2 gender	Male Female
Student 2 - any medical conditions
If you are enrolling more than 2 students please list in a separate document and attach below
Additonal student information
Medical Conditions
If your child/ren has Asthma/Anaphylaxis, do they have a managment plan?	Yes, please attach a copy below No
Anaphylaxis management plan
Does the parent or carer have any medical conditions which may affect participation? * (required)	Yes No
If a parent or carer is needed in the water with the swimming child, medical history is needed.
Concession Details
Do you have a concession card? * (required)	Yes No
Card type
Card expiry dateCard expiry date	RadDatePicker RadDatePicker Open the calendar popup. Calendar Title and navigation Title and navigation << < January 2021 > << January 2021   M T W T F S S 53 28 29 30 31 1 2 3 2 4 5 6 7 8 9 10 3 11 12 13 14 15 16 17 4 18 19 20 21 22 23 24 5 25 26 27 28 29 30 31 6 1 2 3 4 5 6 7
Any additional information
Declaration
I have read and agree to all the rules set out in this enrolment form * (required)	I agree
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Terms and Rules

1. That while I am at the centre or taking part in any activity organised by the centre that I am responsible for my own property.
2. That while I am at the centre or taking part in any activity organised by the centre that I am responsible for my own safety.
3. I will not hold East Gippsland Shire Council liable for any personal injury or loss of property which may happen because of any negligent act or omission or other default of East Gippsland Shire Council or anybody acting on their behalf.
4. That I am physically fit and able to engage in exercise and fitness programs at the centre.
5. I will tell East Gippsland Shire Council in writing of any change to my physical fitness, ability to engage in exercise and fitness programs at the centre.
6. The Aquatic and Recreation Centres are operated on behalf of East Gippsland Shire Council. All membership database information belongs to the East Gippsland Shire Council. All financial details will be kept private. East Gippsland Shire Council will not disclose your financial information unless an alleged incorrect or wrongful debt is raised.
7. Lessons are only run during school terms. Lessons don’t run on public holidays. Make up lessons are not offered.

Lesson Days

If the student is attending Learn to Swim Lessons, up to two adults may swim for free at the same time. The parent or guardian must enter the centre with the child.

If the student is enrolled in school age classes, the membership allows them to swim before or after the lesson with parent or guardian supervision.

Supervision

Children under 10 years must be with accompanied into the facility and constantly supervised by a parent or guardian. The parent or guardian must have a clear view of the child at all times. The parent or guardian must be close to the child with no barriers in the way. Children under the age of 5 years must be constantly supervised and remain within arm’s reach. If child is in the water, parent or guardian must be in the water too. For further details please visit www.watcharoundwater.com.au.

Family Swim Passes

A credit towards future lessons will be provided upon presentation of a medical certificate. Only upto 2 family swim passes per school term will be issued for lessons missed with no medical certificate, but a phone call to the centre before the lesson is needed.

Fee Structure

The fees for Aquatic Education are determined by the level you/your child/children are in. There are 3 different fee charges due to participant/instructor ratios and class length changes. These three fee charges are for; Wonder Award, Courage – Active Award and Adult/Squad.

Term Payment

Full payment is needed before the first lesson. Payment is accepted by cash, cheque, eftpos or credit card. Please note: Account balances from the last instalment period must be settled and up to date, before being able to continue in the following term.

Member ID Card

Students will be issued with a membership ID card which must be presented at reception each visit.

Direct Debit Membership

Aquatic Education direct debit membership is ongoing. Suspension option is not available. If you wish to cancel your membership you must tell the Aquatic Education Team Leader and complete a Membership Cancellation or Suspension form at the centre 10 days before your next direct debit date. Students who are currently enrolled paying by the direct debit option can use the pool at any time.

Cancellations

Your booking for each child will be maintained for the entire year (4 terms) unless you tell us that you wish cancel 2 weeks before the end of the current term.

Privacy Statement

The East Gippsland Shire Council asks for details about you to collect rates, approve permits and licences, and run a range of community services.  The information you give to us on this form is used only for the reasons set out in the form and is not given to anybody else. Sometimes we may supply details about you to someone else, but only if we are allowed by law, or to protect someone or property.

When information is given out, Council will always try to make sure your privacy is protected in line with the Privacy and Data Protection Act 2014.  You may ask for more information about Council’s Privacy Policy by contacting our Information Privacy Officer on 03 5153 9500 or e-mail feedback@egipps.vic.gov.au