Swim Confident - Splash Academy Swim School

By completing this form in no way obligates you to enrolment with Swim Confident and/or Splash Academy. The following form captures necessary information to assist with providing you suitable options for you and/or your family.

Family Details

Full Name (Parent / Carer)

Contact Details

Email (required)

Mobile (required)

Home Telephone

Are you seeking a spot in group classes or private lessons?
Group infant class - $18/class. Ages 6-36mths. Fridays @ 4pm only
Group learn to swim - starts at $21/class.
Private - weekdays - $42 per 30 minute session
Private - Saturday/after hours - $60 per 30 minute session
Private - Saturday/after hours - $85 per 45 minute session
Private - Saturday/after hours - $110 per 60 minute session

My swimmer/s are available during the day for swimming

Preferred lesson times & days. Select as many as you have available - please note not all will be available due to current enrolments
Mondays 8:30am to 12pm
Tuesdays 3pm to 6pm
Wednesdays 8:30am to 12pm
Wednesdays 12pm to 3pm
Wednesdays 3pm to 6pm
Thursdays 8:30am to noon
Thursdays 12pm to 3pm
Thursdays 3pm to 6pm
Fridays 8:30am to 12pm
Fridays 12pm to 3pm
Fridays 3pm to 6pm
Saturdays 9am to 12pm (private sessions only)
Weekdays before 8:30am (private sessions only)
Weekends before 9am (private sessions only)
Weekdays after 6pm (after hours)

How did you hear about Swim Confident - Splash Academy Swim School

Student Details

Student 1

Student Name (required)

Date of Birth / Gender

Availability

Are there any pre-existing medical / chronic conditions, disabilities, allergies or health issues which, you feel, may impede, restrict or affect lessons? If yes, please provide details.

Has the student taken swimming lessons before?

If so, when, where & approximately for how long?

To the best of your knowledge, what is the student's current swimming ability?

Can your swimmer (tick all that apply)
happily & independently get in the water
submerge & explore happily
float on front happily
float on back happily
jump into deep water & return to pool wall safely with some assistance
jump into deep water & return to pool wall safely without assistance
swim freestyle
swim backstroke
able to butterfly kick
able to breaststroke kick
independently move through the water for 2-3mtrs
confidently scull through the water for 5-10mtrs
confidently swim 25mtrs freestyle
confidently swim at least 50mtrs freestyle
confidently swim at least 100mtrs freestyle
none of the above due to fear
not sure of any - has never been in lessons but loves to splash around
not sure of any - starting at the beginning

Unsure of your swimmer's abilities & wish to join group classes? BOOK FOR A FREE ASSESSMENT
yes

Does the student have any specific goals?

Does the student have any fears or anxieties about water or swimming? If yes, please provide details which may be helpful

Additional Information

Additional Information / Special Requests