Enrolment Form | Nereids Aquatic Coaching

Your Contact Information

First Name*

Last Name*

Email*

Address*

Phone*

Postcode*

What is your occupation?

Do you have access a pool?* Yes No

If you have access to Housing community pool, relative's or friend's pool, or requested permission prior registering from a gym or a public pool, you can change your answer to yes

Student Information

How Many Students are you enrolling?*

STUDENT 1 FULL NAME*

Swimming Experience

time1

Date of Birth*

my age

Do you Have an Active Kids Voucher? Yes No

Give Voucher Number

Are You an NSW Senior Card Member? You can get 10% Discount Yes No

STUDENT 2 FULL NAME*

Swimming Experience

time2

Date of Birth*

my age

Do you Have an Active Kids Voucher? Yes No

Give Voucher Number

Are You an NSW Senior Card Member? You can get 10% Discount Yes No

STUDENT 3 FULL NAME*

Swimming Experience

time3

Date of Birth*

my age

Do you Have an Active Kids Voucher? Yes No

Give Voucher Number

Are You an NSW Senior Card Member? You can get 10% Discount Yes No

STUDENT 4 FULL NAME*

Swimming Experience

time4

Date of Birth*

my age

Do you Have an Active Kids Voucher? Yes No

Give Voucher Number

Are You an NSW Senior Card Member? You can get 10% Discount Yes No

STUDENT 5 FULL NAME*

Swimming Experience

Date of Birth*

my age

Do you Have an Active Kids Voucher? Yes No

Give Voucher Number

Are You an NSW Senior Card Member? You can get 10% Discount Yes No

STUDENT 6 FULL NAME*

Swimming Experience

Date of Birth*

my age

Do you Have an Active Kids Voucher? Yes No

Give Voucher Number

Are You an NSW Senior Card Member? You can get 10% Discount Yes No

Goals and Timeline*

Medical Condition*

Are you the Parent/Guardian of all the students?* Yes No Not Applicable

How many additional Parent/Guardians are there for the students you are enrolling? *

Parent/Guardian Name*

Email*

Phone*

What is your occupation?

Parent/Guardian Name: **

Email*

Phone

What is your occupation?

Parent/Guardian Name: **

Email*

Phone

What is your occupation?

Parent/Guardian Name: **

Email*

Phone

What is your occupation?

Parent/Guardian Name: **

Email*

Phone

What is your occupation?

Parent/Guardian Name: **

Email*

Phone

What is your occupation?

Swim Lesson Package Selection

Based upon the students ages, we recommend the following lesson length to be split among the swimmers:

How long would you like each swimming lesson to last for

The following fees are only for one-on-one lessons. Different fees apply for group lessons (students having lessons together at the same time).
You may please choose as many lessons as you want.
Our lessons fees are flat for any number from six lessons and above. Different fees apply between one and five lessons.

30 minutes 45 minutes 60 minutes 90 minutes 120 minutes

BASIC (1-5 lessons)

Number of lessons

value1

Select

STARTER (6+ lessons)

Number of lessons

value2

Select

PRIVATE SWIMMING LESSONS
IN YOUR OWN POOL

PRIVATE SWIMMING LESSONS
IN YOUR OWN POOL

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