Prorated Enrolment Request Form
Our current Term 3 27 Jan - 11 April has commenced. Please complete this form to arrange a prorated enrolment commencing from the selected start date below:

**Pool entry of $3 per swimming student applies and is separate to swimming fees.
Please select the first day you are available to commence a prorated enrolment. *
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Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Participant's Date of Birth *
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Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
Parent/Guardian's Email Address *
Your answer
Mobile Number *
Your answer
Postal Address *
Your answer
Multiple Lessons Per Week? *
Please select swimming level *
if you are unsure of what class or swim level please email us at office@mermaidswim.com.au
Please select day of class *
Please select time slot *
Only complete if you have chosen to enrol your child for multiple lessons per week.
If you are booking more than 1 lesson a week, please let us know the day and time for the second and/or third lesson. Upon completing your booking and payment we will manually enter your subsequent lessons in our booking system.
Your answer
Other preferred days and time slots *
Please let us know if there are any other days and times suitable for your child's lesson. If we are no longer able to offer the day of your initial booking we will contact you with alternative days based on your noted preferences.
Your answer
If you wish to use your $100 Active Kids voucher please add voucher number here*
Your answer
Medical Notes
Your answer
Questions or Other notes?
Your answer
How did you hear about us?
I agree to the terms and conditions stated here. *
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