Impilo Swimming - Lesson Break application form
This form is where you as our valued swimmer inform us of dates to which you will not be able to attend lessons for a period of BETWEEN  TWO WEEKS OR TWO MONTHS. Kindly note  the terms and conditions below.
5.4. Break periods within the standard annual contract (January to December)
A swimmer is hereby granted the option of taking a total maximum of two months (60 days) break over a consecutive 12-month calendar period within the same year. Subject to:
5.4.1. 30 days’ notice requested prior to the break.
5.4.2. Applied for via the Google form link found on, no verbal, written, email or messaged notice will be accepted.
5.4.3. Written approval from Impilo Swimming as a reply to the Google link mentioned in clause 5.4.2.
5.4.4.  Subject to the paying of the “Impilo Swimming Temporary Account suspension” fee of R100 per month or part thereof.
5.4.5. Reasons for taking a break can  be considered based on the following: School holidays (based on the official terms calendar released by the department of education) Winter break December Holiday (15th December 15th January) Medical reason, subject to doctor note Personal reasons such as prolonged sickness, death, or personal loss.(doctors notes provided)

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Email *
Name of parent/ Guardian *
Swimmer  name? *
Account number? *
Reason for stopping? *
Date of last Session with us? *
Date of starting lessons again? *
Do you agree to Pay the R100 as per 5.4.4. *
General comments? *
Do you agree with the Terms an Conditions stated above? *
A copy of your responses will be emailed to the address you provided.
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